Provider Demographics
NPI:1952408221
Name:JUENEMANN, RONALD J (OD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:J
Last Name:JUENEMANN
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 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
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219890BMedicaid
KS0623020001OtherMEDICARE DMERC
KS0623020001OtherMEDICARE DMERC
U44341Medicare UPIN