Provider Demographics
NPI:1164471462
Name:BRAND, RONALD A (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:BRAND
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 1:1702 N. BALTIMORE ST.
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2485
Mailing Address - Country:US
Mailing Address - Phone:660-665-6262
Mailing Address - Fax:660-665-5908
Practice Address - Street 1:1702 N. BALTIMORE ST.
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2485
Practice Address - Country:US
Practice Address - Phone:660-665-6262
Practice Address - Fax:660-665-5908
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002575152W00000X
IL046007820152W00000X
MOT02642152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1164471462Medicaid
MO317965804Medicaid
IA1164471462Medicaid
MO166876OtherHEALTHLINK
T42588Medicare UPIN
MOGP 990001397/9309Medicare ID - Type Unspecified
MO317965804Medicaid