Provider Demographics
NPI:1801887922
Name:ANDERSON, RONALD JOE (OD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOE
Last Name:ANDERSON
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 1:365 CAPITAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-4829
Mailing Address - Country:US
Mailing Address - Phone:269-962-4011
Mailing Address - Fax:269-962-4012
Practice Address - Street 1:365 CAPITAL AVE NE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-4829
Practice Address - Country:US
Practice Address - Phone:269-962-4011
Practice Address - Fax:269-962-4012
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI410022144152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU23839Medicare UPIN
MI0214110001Medicare NSC
MI410022144Medicare ID - Type UnspecifiedRAILROAD
MI900A36509Medicare ID - Type UnspecifiedBCBS-MI
MIOA36509Medicare ID - Type Unspecified