Provider Demographics
NPI:1962423962
Name:HIRN, RONALD A (OD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:HIRN
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 1:1716 UNIVERSITY BLVD
Mailing Address - Street 2:G080A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0010
Mailing Address - Country:US
Mailing Address - Phone:205-975-2020
Mailing Address - Fax:205-934-6755
Practice Address - Street 1:1058 E LOS EBANOS BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9988
Practice Address - Country:US
Practice Address - Phone:956-541-4828
Practice Address - Fax:956-541-4568
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT-234-TA-B13152W00000X
TX03479TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116466704Medicaid
TX116466704Medicaid