Provider Demographics
NPI:1003843087
Name:JANDA, RONALD F (OD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:F
Last Name:JANDA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 SYLVAN AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1692
Mailing Address - Country:US
Mailing Address - Phone:209-575-2020
Mailing Address - Fax:209-758-5693
Practice Address - Street 1:1011 SYLVAN AVE
Practice Address - Street 2:STE. A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1692
Practice Address - Country:US
Practice Address - Phone:209-575-2020
Practice Address - Fax:209-758-5693
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8748T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0087480Medicare PIN
0485740001Medicare NSC
SD0087481Medicare PIN
U10116Medicare UPIN