Provider Demographics
NPI:1407806920
Name:MIXON, RON DWAINE (OD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:DWAINE
Last Name:MIXON
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 474
Mailing Address - Street 2:
Mailing Address - City:POTEET
Mailing Address - State:TX
Mailing Address - Zip Code:78065-0474
Mailing Address - Country:US
Mailing Address - Phone:830-569-3334
Mailing Address - Fax:830-281-3926
Practice Address - Street 1:2151 W OAKLAWN RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4604
Practice Address - Country:US
Practice Address - Phone:830-569-3334
Practice Address - Fax:830-281-3926
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5812TG152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019148801Medicaid
TX000742EMedicare ID - Type Unspecified