Provider Demographics
NPI:1457393969
Name:LUXENBURG, RONALD FRANKLIN (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:FRANKLIN
Last Name:LUXENBURG
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 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:7367 ATLAS WALK WAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-2992
Practice Address - Country:US
Practice Address - Phone:703-753-7200
Practice Address - Fax:703-753-7661
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00425900152W00000X, 152WC0802X
VA0618003170152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
T77811Medicare UPIN
NJ148507Medicare ID - Type Unspecified