Provider Demographics
NPI:1215060223
Name:KAISER, RON P (OD)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:P
Last Name:KAISER
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 1:106 MIERS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-3081
Mailing Address - Country:US
Mailing Address - Phone:830-775-6567
Mailing Address - Fax:830-768-3503
Practice Address - Street 1:106 MIERS ST STE A
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-3082
Practice Address - Country:US
Practice Address - Phone:830-775-6567
Practice Address - Fax:830-768-3503
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06160TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00614UOtherU87685
TX147654102Medicaid
TX80763QOtherBLUE CROSS AND BLUE SHIEL
TX147654102Medicaid
TXU87685Medicare UPIN