Healthcare Provider Details

I. General information

NPI: 1952408221
Provider Name (Legal Business Name): RONALD J JUENEMANN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 5TH STREET
PHILLIPSBURG KS
67661
US

IV. Provider business mailing address

PO BOX 509
PHILLIPSBURG KS
67661
US

V. Phone/Fax

Practice location:
  • Phone: 785-543-2715
  • Fax: 785-543-6556
Mailing address:
  • Phone: 785-543-2715
  • Fax: 785-543-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13993
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: