Healthcare Provider Details

I. General information

NPI: 1063547693
Provider Name (Legal Business Name): RON T. NG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E CHAPEL ST
SANTA MARIA CA
93454-4522
US

IV. Provider business mailing address

610 E CHAPEL ST
SANTA MARIA CA
93454-4522
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-2020
  • Fax: 805-928-8208
Mailing address:
  • Phone: 805-928-2020
  • Fax: 805-928-8208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5917T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: