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General NPI Number Information
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NPI Number | 1568762151
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Entity Type | Organization
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Legal Business Name | RONALD L OGREN, O.D. INCORPORATED
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 10/18/2011
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Provider Practice Location Address
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Address Line | 808 N NORMA ST
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City | RIDGECREST
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State | CA
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Zip | 93555-3509
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Country | US
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Telephone | 760-375-4496
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Fax | 760-375-5895
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Provider Business Mailing Address
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Address Line | 808 N NORMA ST
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City | RIDGECREST
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State | CA
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Zip | 93555-3509
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Country | US
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Telephone | 760-375-4496
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Fax | 760-375-5895
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CLAUDIA SUE GARDNER
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Credential |
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Telephone | 760-375-4496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5191
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License Number State | CA
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