Provider Demographics
NPI:1588653752
Name:HARRISON, RONALD C (OD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:HARRISON
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 1:2320 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-5017
Mailing Address - Country:US
Mailing Address - Phone:707-526-2020
Mailing Address - Fax:707-526-2032
Practice Address - Street 1:2320 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-5017
Practice Address - Country:US
Practice Address - Phone:707-526-2020
Practice Address - Fax:707-526-2032
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000145741152W00000X
TX2555T152W00000X
CAOPT 6943 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U85209Medicare UPIN
MO000091268Medicare PIN