Provider Demographics
NPI:1972635266
Name:AMAKER, RONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:AMAKER
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 1:5722 GUNPOWDER RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-8379
Mailing Address - Country:US
Mailing Address - Phone:828-313-0361
Mailing Address - Fax:
Practice Address - Street 1:845 BLOWING ROCK BLVD
Practice Address - Street 2:SUITE R
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-3766
Practice Address - Country:US
Practice Address - Phone:828-757-2816
Practice Address - Fax:828-757-2864
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT65069Medicare UPIN
NC246547DMedicare ID - Type Unspecified