Provider Demographics
NPI:1699727438
Name:PIFFL, RONALD JAMES (OD,)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:PIFFL
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 1:205 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3000
Mailing Address - Country:US
Mailing Address - Phone:715-848-2020
Mailing Address - Fax:715-845-6669
Practice Address - Street 1:1007 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-2511
Practice Address - Country:US
Practice Address - Phone:715-536-3250
Practice Address - Fax:715-722-0411
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2560152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38589400Medicaid
WIU45099Medicare UPIN
WI38589400Medicaid
WIU45099Medicare UPIN
WI38589400Medicaid