Provider Demographics
NPI:1013087725
Name:POGACH, RONALD SIDNEY (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SIDNEY
Last Name:POGACH
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 1:5503 KIRKWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5001
Mailing Address - Country:US
Mailing Address - Phone:302-994-3300
Mailing Address - Fax:302-994-3782
Practice Address - Street 1:5503 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5001
Practice Address - Country:US
Practice Address - Phone:302-994-3300
Practice Address - Fax:302-994-3782
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEDE1130OtherVBA I.D.
DE81370OtherSPECTERA I.D.
DE33296OtherCOVENTRY I.D.
DE30504OtherGVA I.D.
DE51-0228512 DE 1130OtherEYEMED I.D.
DET-26918Medicare UPIN
DE33296OtherCOVENTRY I.D.