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General NPI Number Information
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NPI Number | 1982756169
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Entity Type | Organization
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Legal Business Name | DR RONN MCDANIEL PA
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 128 2ND ST NW
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City | ORTONVILLE
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State | MN
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Zip | 56278-1409
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Country | US
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Telephone | 320-839-3413
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 E 25TH ST
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City | HIBBING
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State | MN
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Zip | 55746-3897
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Country | US
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Telephone | 320-839-3413
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONN MCDANIEL
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Credential | OD
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Telephone | 320-839-3413
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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 | 2619
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License Number State | MN
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