Provider Demographics
NPI:1063547693
Name:NG, RON T (OD)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:T
Last Name:NG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4522
Mailing Address - Country:US
Mailing Address - Phone:805-928-2020
Mailing Address - Fax:805-928-8208
Practice Address - Street 1:610 E CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4522
Practice Address - Country:US
Practice Address - Phone:805-928-2020
Practice Address - Fax:805-928-8208
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5917T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0059170Medicaid
CASD0059170Medicaid
CAOP5917Medicare ID - Type Unspecified