Provider Demographics
NPI:1710098710
Name:ZUBA, RONALD D (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:D
Last Name:ZUBA
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 1:6961 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1142
Mailing Address - Country:US
Mailing Address - Phone:803-732-4166
Mailing Address - Fax:
Practice Address - Street 1:6961 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1142
Practice Address - Country:US
Practice Address - Phone:803-732-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC756152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD07561Medicaid
SCT83735Medicare UPIN
SC7837350281Medicare ID - Type Unspecified
SCT837359243Medicare PIN