Provider Demographics
NPI:1568560233
Name:ADERHOLT, RONALD LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LYNN
Last Name:ADERHOLT
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 1:333 E CHOCCOLOCCO ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1225
Mailing Address - Country:US
Mailing Address - Phone:256-831-2040
Mailing Address - Fax:256-831-2716
Practice Address - Street 1:333 E CHOCCOLOCCO ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1225
Practice Address - Country:US
Practice Address - Phone:256-831-2040
Practice Address - Fax:256-831-2716
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-540-TA-102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058323Medicaid
ALT68303Medicare UPIN
AL000058323Medicare ID - Type Unspecified