Provider Demographics
NPI:1982756169
Name:DR RONN MCDANIEL PA
Entity type:Organization
Organization Name:DR RONN MCDANIEL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-839-3413
Mailing Address - Street 1:1200 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3897
Mailing Address - Country:US
Mailing Address - Phone:320-839-3413
Mailing Address - Fax:
Practice Address - Street 1:128 2ND ST NW
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MN
Practice Address - Zip Code:56278-1409
Practice Address - Country:US
Practice Address - Phone:320-839-3413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9200830Medicaid
MNDP3657OtherRAIL ROAD MEDICARE
MN2212701OtherMEDICA
MN5C859MCOtherBLUE CROSS BLUE SHIELD
MN121080OtherUCARE
MN5C856MCOtherBLUE CROSS BLUE SHIELD
MN848152100Medicaid
SDS42523OtherNORIDIAN
MNDP3657OtherRAIL ROAD MEDICARE
MN848152100Medicaid
SDS42523Medicare PIN