Provider Demographics
NPI:1376521146
Name:SUAREZ, RONALD J (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:OD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4900 N GLEN PARK PLACE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4679
Mailing Address - Country:US
Mailing Address - Phone:309-691-4500
Mailing Address - Fax:309-693-2536
Practice Address - Street 1:4900 N GLEN PARK PLACE RD
Practice Address - Street 2:SUITE C
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4679
Practice Address - Country:US
Practice Address - Phone:309-691-4500
Practice Address - Fax:309-693-2536
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT77768Medicare UPIN