Provider Demographics
NPI:1528038510
Name:MILAM, RONALD W (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:W
Last Name:MILAM
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 1:303 DAVIE AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5318
Mailing Address - Country:US
Mailing Address - Phone:704-873-4681
Mailing Address - Fax:
Practice Address - Street 1:303 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5318
Practice Address - Country:US
Practice Address - Phone:704-872-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMMM0066616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909636Medicaid
NC246292Medicare PIN
NCT64383Medicare UPIN
NC0290860001Medicare NSC
NCP00837519Medicare PIN