Individual
DR. RYAN SCOTT THOELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1505 W MAIN ST, MT ZION, IL 62549-1300
(217) 864-3221
(217) 596-4670
Mailing address
2445 BROADWAY ST, QUINCY, IL 62301-3257
(217) 222-8800
(217) 222-8801
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010469
IL
152W00000X
Optometrist
2013000824
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700144029
—
IL
05
—
1700144029
—
MO
Enumeration date
04/24/2012
Last updated
02/22/2018
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