Provider Demographics
NPI:1144206657
Name:BERGGREN, RONALD K (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:K
Last Name:BERGGREN
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 1:26 GOLDEN EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-5742
Mailing Address - Country:US
Mailing Address - Phone:303-979-3475
Mailing Address - Fax:303-979-5124
Practice Address - Street 1:6565 W JEWELL AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7102
Practice Address - Country:US
Practice Address - Phone:303-936-1671
Practice Address - Fax:303-936-6230
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO892152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT60884Medicare UPIN
CO75003Medicare ID - Type Unspecified