Provider Demographics
NPI:1902336076
Name:VIKESLAND, RYAN (OD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:VIKESLAND
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 1:114 MISSION RANCH BLVD STE 50
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-5137
Mailing Address - Country:US
Mailing Address - Phone:530-891-1900
Mailing Address - Fax:530-895-1531
Practice Address - Street 1:114 MISSION RANCH BLVD STE 50
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-5137
Practice Address - Country:US
Practice Address - Phone:530-891-1900
Practice Address - Fax:530-895-1531
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33680152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist