Provider Demographics
NPI:1215072673
Name:GENAUER, RONALD (OD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:GENAUER
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 1:172 E LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-2860
Mailing Address - Country:US
Mailing Address - Phone:831-422-2224
Mailing Address - Fax:831-757-4220
Practice Address - Street 1:172 E LAUREL DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-2860
Practice Address - Country:US
Practice Address - Phone:831-422-2224
Practice Address - Fax:831-757-4220
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7470T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0074700-5Medicaid
94-2852587OtherFED. EMPLOYER ID
T10539Medicare UPIN