Provider Demographics
NPI:1922841352
Name:PEARDON, RYAN GEOFFREY
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:GEOFFREY
Last Name:PEARDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 S LAKE HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-2635
Mailing Address - Country:US
Mailing Address - Phone:863-604-8714
Mailing Address - Fax:
Practice Address - Street 1:3350 HARDEN BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-7977
Practice Address - Country:US
Practice Address - Phone:863-662-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist