Provider Demographics
NPI:1528142122
Name:MARTIN, RONALD JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:MARTIN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1440 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2987
Mailing Address - Country:US
Mailing Address - Phone:707-206-0290
Mailing Address - Fax:707-585-8018
Practice Address - Street 1:1440 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2987
Practice Address - Country:US
Practice Address - Phone:707-206-0290
Practice Address - Fax:707-585-8018
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA11182T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist