Provider Demographics
NPI:1548398837
Name:JURCAK, RONALD KEVIN (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:KEVIN
Last Name:JURCAK
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 1:16706 CHILLICOTHE RD 500
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4573
Mailing Address - Country:US
Mailing Address - Phone:440-708-0020
Mailing Address - Fax:440-708-0302
Practice Address - Street 1:16706 CHILLICOTHE RD 500
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4573
Practice Address - Country:US
Practice Address - Phone:440-708-0020
Practice Address - Fax:440-708-0302
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3865152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2529900OtherUNITED HEALTHCARE
OH000000228073OtherANTHEM
OH0618261Medicare PIN
OHT96113Medicare UPIN
OH000000228073OtherANTHEM