Provider Demographics
NPI:1669540837
Name:ROWLAND, RONNIE JAY (OD)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:JAY
Last Name:ROWLAND
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:PO BOX 505
Mailing Address - Street 2:115 GILLIAM ST
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565
Mailing Address - Country:US
Mailing Address - Phone:919-693-4611
Mailing Address - Fax:919-693-4612
Practice Address - Street 1:2531 F LIME STATION RD
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522
Practice Address - Country:US
Practice Address - Phone:919-528-3819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1231152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909080Medicaid
NC09080OtherBCBS
NC8909080Medicaid
CN2447Medicare UPIN