Provider Demographics
NPI:1013012715
Name:PUGH, RONALD M (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
Last Name:PUGH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:321 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-2024
Mailing Address - Country:US
Mailing Address - Phone:801-798-7496
Mailing Address - Fax:801-373-2144
Practice Address - Street 1:2696 NO UNIVERSITY AVE
Practice Address - Street 2:#100A
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-373-0440
Practice Address - Fax:801-373-2144
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT302152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000009317Medicare ID - Type Unspecified