Provider Demographics
NPI:1801318977
Name:NAGLAK, RYAN (OD)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:NAGLAK
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 1:3046 KNIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2815
Mailing Address - Country:US
Mailing Address - Phone:215-639-4500
Mailing Address - Fax:215-604-0250
Practice Address - Street 1:720 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3844
Practice Address - Country:US
Practice Address - Phone:610-933-3498
Practice Address - Fax:610-933-5052
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00677700152W00000X
PAOEG003282152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist