1033954599 NPI number — DR. RYAN AMBROSE, PLLC

Table of content: OSCAR MUNIZ M.S, B.C.A.T (NPI 1982254272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033954599 NPI number — DR. RYAN AMBROSE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. RYAN AMBROSE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033954599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6761 E KELTON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85254-5645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-295-5154
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3870 W HAPPY VALLEY RD STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85310-3296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-362-8642
Provider Business Practice Location Address Fax Number:
623-561-1190
Provider Enumeration Date:
06/27/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AMBROSE
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER/OPTOMETRIST
Authorized Official Telephone Number:
262-295-5154

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1558711507 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".