Provider Demographics
NPI:1669705521
Name:RON'S OPTICAL, INC
Entity type:Organization
Organization Name:RON'S OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:A
Authorized Official - Last Name:PUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-784-1668
Mailing Address - Street 1:52 E MILL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3841
Mailing Address - Country:US
Mailing Address - Phone:559-784-1668
Mailing Address - Fax:559-784-1668
Practice Address - Street 1:52 E MILL AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3841
Practice Address - Country:US
Practice Address - Phone:559-784-1668
Practice Address - Fax:559-784-1668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD6251332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9160OtherMEDICAL EYE SERVICES
CADX006251FMedicaid
CADX006251FMedicaid