Provider Demographics
NPI:1114220225
Name:DR. RONALD J. PIFFL, OPTOMETRIST, LLC
Entity Type:Organization
Organization Name:DR. RONALD J. PIFFL, OPTOMETRIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PIFFL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-536-3250
Mailing Address - Street 1:1007 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-2511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1007 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-2511
Practice Address - Country:US
Practice Address - Phone:715-536-3250
Practice Address - Fax:715-536-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2560152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38589400Medicaid
U45099Medicare UPIN
WI6501350001Medicare NSC