Provider Demographics
NPI:1093709602
Name:MILOVICH, RONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:MILOVICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:RONALD
Other - Middle Name:
Other - Last Name:MILOVICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2004 EDISON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1712
Mailing Address - Country:US
Mailing Address - Phone:574-288-2400
Mailing Address - Fax:574-288-7132
Practice Address - Street 1:2004 EDISON RD
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1712
Practice Address - Country:US
Practice Address - Phone:574-288-2400
Practice Address - Fax:574-288-7132
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001593A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100273116OtherBLUE CROSS SOUTH BEND
IN351368448OtherVISION CARE PLAN
IN01171OtherSPECTERA
IN100150490Medicaid
IN351368448OtherVISION SERVICE PLAN
ININ81594OtherVISIONBENEFITS OF AMERICA
IN32790OtherINDIANA HEALTH NETWORK
IN118467OtherEYE MED SO BEND
IN100273116OtherBLUE CROSS SOUTH BEND
IN2550910001Medicare NSC
IN100150490Medicaid
IN118467OtherEYE MED SO BEND
IN194030AMedicare PIN