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Individual

DR. RYAN ROGER MANNING

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(602) 263-1635
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1200

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
1730
AZ
152W00000X
Optometrist
Primary
59594209934
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1730
ARIZONA OPTOMETRY LICENSE
AZ
Enumeration date
01/23/2006
Last updated
05/02/2019
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