Provider Demographics
NPI:1669432969
Name:VERXAGIO, RYAN C (OD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
Last Name:VERXAGIO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 SILK OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1367
Mailing Address - Country:US
Mailing Address - Phone:305-439-2015
Mailing Address - Fax:305-503-9250
Practice Address - Street 1:1315 SILK OAK DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1367
Practice Address - Country:US
Practice Address - Phone:305-439-2015
Practice Address - Fax:305-503-9250
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3957152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4879VOtherMEDICARE UPIN (BROWARD)
FL621009100Medicaid
FLCV355AMedicare UPIN
FLU4879WMedicare UPIN
FL621009100Medicaid