Provider Demographics
NPI:1780909077
Name:PEI, RONALD C (OD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:PEI
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 1:6301 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-8129
Mailing Address - Country:US
Mailing Address - Phone:301-455-1115
Mailing Address - Fax:817-916-9510
Practice Address - Street 1:6301 DAVIS RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-8129
Practice Address - Country:US
Practice Address - Phone:301-455-1115
Practice Address - Fax:817-916-9510
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7185T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist