Basic Information
| Provider Information | |||||||||
| NPI: | 1871047613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KWAN | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 198 SW BROAD ST | ||||||||
| Address2: | |||||||||
| City: | JESUP | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315451101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125306000 | ||||||||
| FaxNumber: | 9125306044 | ||||||||
| Practice Location | |||||||||
| Address1: | 4875 ALTAMA AVE | ||||||||
| Address2: | |||||||||
| City: | BRUNSWICK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315202912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125540010 | ||||||||
| FaxNumber: | 9125540075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2016 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT002966 | GA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.