Provider Demographics
NPI:1770546228
Name:NORLUND, RONALD K (OD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:K
Last Name:NORLUND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7747 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4135
Mailing Address - Country:US
Mailing Address - Phone:260-459-8444
Mailing Address - Fax:260-459-8443
Practice Address - Street 1:7747 W JEFFERSON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-459-8444
Practice Address - Fax:260-459-8443
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002551A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100324540Medicaid
U27214Medicare UPIN
IN669220BMedicare PIN
IN160450030Medicare PIN
IN100324540Medicaid
IN452570024Medicare PIN
INM400037163Medicare PIN
IN402670BMedicare PIN