Provider Demographics
NPI:1457341034
Name:KICHURA, RONALD MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MICHAEL
Last Name:KICHURA
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 1:9612 SAINT GEORGE CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8648
Mailing Address - Country:US
Mailing Address - Phone:907-696-0929
Mailing Address - Fax:907-580-1152
Practice Address - Street 1:5955 ZEAMER AVE
Practice Address - Street 2:3 MDG OPTOMETRY CLINIC
Practice Address - City:ELMENDORF AFB
Practice Address - State:AK
Practice Address - Zip Code:99506-3702
Practice Address - Country:US
Practice Address - Phone:907-580-1150
Practice Address - Fax:907-580-1152
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA 182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist