Provider Demographics
NPI:1164415394
Name:BRINEGAR, RONALD JOE (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOE
Last Name:BRINEGAR
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 1:30 N EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-8895
Mailing Address - Country:US
Mailing Address - Phone:317-881-3937
Mailing Address - Fax:317-887-4008
Practice Address - Street 1:30 N EMERSON AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143
Practice Address - Country:US
Practice Address - Phone:317-881-3937
Practice Address - Fax:317-887-4008
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002852A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000015929OtherMPLAN
IN100362860Medicaid
IN352129520OtherUNITED MINE WORKERS
IN154418OtherCOLE VISION
IN410047205OtherRAILROAD MEDICARE
IN000000214767OtherBCBS
IN0005501569OtherAETNA
IN000000015929OtherMPLAN
IN154418OtherCOLE VISION