Provider Demographics
NPI:1649482183
Name:RONALD J. JUENEMANN, O.D., P.A.
Entity type:Organization
Organization Name:RONALD J. JUENEMANN, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:JUENEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-543-2715
Mailing Address - Street 1:P.O. BOX 509
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661
Mailing Address - Country:US
Mailing Address - Phone:785-543-2715
Mailing Address - Fax:785-543-6556
Practice Address - Street 1:655 5TH STREET
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661
Practice Address - Country:US
Practice Address - Phone:785-543-2715
Practice Address - Fax:785-543-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1952408221OtherINDIVIDUAL NPI NUMBER
KS650766Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
KS650525Medicare ID - Type UnspecifiedGROUP NUMBER
KS1952408221OtherINDIVIDUAL NPI NUMBER
U44341Medicare UPIN