Individual
NICHOLAS RYAN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3200 S UNIVERSITY DR, DAVIE, FL 33328-2018
(954) 262-4200
Mailing address
PO BOX 290370, DAVIE, FL 33329-0370
(954) 262-4200
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2042
SC
152W00000X
Optometrist
2929
OK
152W00000X
Optometrist
Primary
OPC6906
FL
152W00000X
Optometrist
Primary
OPFC97
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D20421
—
SC
Enumeration date
04/18/2017
Last updated
04/16/2026
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