Provider Demographics
NPI:1285647362
Name:PYCRAFT, RONALD A (OD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:PYCRAFT
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 1:306 OAKLEY RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2130
Mailing Address - Country:US
Mailing Address - Phone:330-264-1452
Mailing Address - Fax:
Practice Address - Street 1:1456 PARK AVE W
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-2700
Practice Address - Country:US
Practice Address - Phone:419-529-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist