Provider Demographics
NPI:1710070727
Name:SHELDON, RONALD B
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:B
Last Name:SHELDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:LONG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55356-0061
Mailing Address - Country:US
Mailing Address - Phone:952-473-2654
Mailing Address - Fax:
Practice Address - Street 1:3601 HIGHWAY 100 S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2500
Practice Address - Country:US
Practice Address - Phone:952-356-3544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2201904OtherMEDICA
MN226523100Medicaid
MN36060SHOtherBCBS OF MN
MN874339OtherDAVISVISION/CLARITY
MN22 02402OtherMEDICA
MN93990OtherHEALTHPARTNERS
MN218241032779OtherPREFERRED ONE
MN911972OtherEYE MED/COLE VISION
MN911972OtherEYE MED/COLE VISION