Basic Information
| Provider Information | |||||||||
| NPI: | 1962559138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMARES | ||||||||
| FirstName: | RYAN | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1121 AMERICAN AVE | ||||||||
| Address2: | |||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531884923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3123715633 | ||||||||
| FaxNumber: | 4147696998 | ||||||||
| Practice Location | |||||||||
| Address1: | 16025 W BLUEMOUND RD | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530056001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627850490 | ||||||||
| FaxNumber: | 2627851690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 04/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2980-036 | WI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.