Healthcare Provider Details

I. General information

NPI: 1053390401
Provider Name (Legal Business Name): RONALD W. DOWNING O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S KENNEBEC AVE
MC CONNELSVILLE OH
43756-1211
US

IV. Provider business mailing address

135 S KENNEBEC AVE
MC CONNELSVILLE OH
43756-1211
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-4567
  • Fax: 740-962-3473
Mailing address:
  • Phone: 740-962-4567
  • Fax: 740-962-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2929
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: