Provider Demographics
NPI:1578892667
Name:ROBERT A RING
Entity Type:Organization
Organization Name:ROBERT A RING
Other - Org Name:BLACK MOUNTAIN OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:O.D
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:RING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-726-9383
Mailing Address - Street 1:3998 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4500
Mailing Address - Country:US
Mailing Address - Phone:760-726-9383
Mailing Address - Fax:760-726-9897
Practice Address - Street 1:3998 VISTA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4500
Practice Address - Country:US
Practice Address - Phone:760-726-9383
Practice Address - Fax:760-726-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6781T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0067811Medicaid
U18582Medicare UPIN
OP6781AMedicare PIN
CASD0067811Medicaid