Provider Demographics
NPI:1710017512
Name:RONALD D. DYMOND
Entity Type:Organization
Organization Name:RONALD D. DYMOND
Other - Org Name:DAR LO SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:DYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:B O C O
Authorized Official - Phone:316-262-0001
Mailing Address - Street 1:553 W DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-4701
Mailing Address - Country:US
Mailing Address - Phone:316-262-0001
Mailing Address - Fax:
Practice Address - Street 1:553 W DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-4701
Practice Address - Country:US
Practice Address - Phone:316-262-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0774900001Medicare ID - Type Unspecified