Provider Demographics
NPI:1699767467
Name:RINGENBACH, ALAN ROGER (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ROGER
Last Name:RINGENBACH
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 1:78 MAIN ST
Mailing Address - Street 2:PO BOX 298
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3111
Mailing Address - Country:US
Mailing Address - Phone:413-584-2121
Mailing Address - Fax:413-584-3400
Practice Address - Street 1:78 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3111
Practice Address - Country:US
Practice Address - Phone:413-584-2121
Practice Address - Fax:413-584-3400
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3727152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0313386Medicaid
U58603Medicare UPIN
W21060Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
W17021Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE