Provider Demographics
NPI:1588640072
Name:BURKS, RONALD A (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:BURKS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:A
Other - Last Name:BURKS OD PA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:305 E KIEHL AVE
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-2921
Practice Address - Country:US
Practice Address - Phone:501-835-3937
Practice Address - Fax:501-835-2040
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR 2273152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR410039902OtherRAILROAD MEDICARE
AR103272722Medicaid
AR49234OtherAR BLUECROSS BLUE SHIELD
AR49234B171OtherAR BLUECROSS BLUESHIELD
AR410000403OtherRAILROAD MEDICARE
AR49234F895OtherAR BLUECROSS BLUESHIELD
ART20293Medicare UPIN
AR49234OtherAR BLUECROSS BLUE SHIELD
AR103272722Medicaid
AR0179280001Medicare NSC
AR49234B171OtherAR BLUECROSS BLUESHIELD
AR49234F895Medicare PIN