Provider Demographics
NPI:1386676880
Name:ROELFS, RON W (OD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:W
Last Name:ROELFS
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:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-0808
Mailing Address - Country:US
Mailing Address - Phone:319-352-2020
Mailing Address - Fax:319-352-0006
Practice Address - Street 1:124 2ND ST NE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677
Practice Address - Country:US
Practice Address - Phone:319-352-2020
Practice Address - Fax:319-352-0006
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2187591Medicaid
IA46987OtherBCBS
IA46987Medicare ID - Type Unspecified
IA46987OtherBCBS
IA1246440001Medicare NSC