Provider Demographics
NPI:1922167444
Name:VAN DRAN, RHONDA K (OD, PC)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:K
Last Name:VAN DRAN
Suffix:
Gender:F
Credentials:OD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5514
Mailing Address - Country:US
Mailing Address - Phone:575-388-2020
Mailing Address - Fax:
Practice Address - Street 1:900 N HUDSON ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5514
Practice Address - Country:US
Practice Address - Phone:575-388-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1562152W00000X
NMOP2403152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMU34130Medicare ID - Type Unspecified