Provider Demographics
NPI:1326214503
Name:RONALD D KIRK O D INC.
Entity Type:Organization
Organization Name:RONALD D KIRK O D INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-678-2324
Mailing Address - Street 1:46 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-2830
Mailing Address - Country:US
Mailing Address - Phone:435-678-2324
Mailing Address - Fax:435-678-3344
Practice Address - Street 1:46 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511-2830
Practice Address - Country:US
Practice Address - Phone:435-678-2324
Practice Address - Fax:435-678-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT521929262017Medicaid
UT521929262017Medicaid