Provider Demographics
NPI:1194719369
Name:SZABO, RONALD WILLIAM (OD)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WILLIAM
Last Name:SZABO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6320 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-2235
Mailing Address - Country:US
Mailing Address - Phone:219-762-1061
Mailing Address - Fax:
Practice Address - Street 1:3151 WILLOWCREEK RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4446
Practice Address - Country:US
Practice Address - Phone:219-762-2111
Practice Address - Fax:219-763-7899
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1479152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist