Provider Demographics
NPI:1992705180
Name:PLOTKIN, RONALD A (OD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:PLOTKIN
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 1:15563 W ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1461
Mailing Address - Country:US
Mailing Address - Phone:480-297-7844
Mailing Address - Fax:
Practice Address - Street 1:15563 W ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1461
Practice Address - Country:US
Practice Address - Phone:480-297-7844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMP0015986OtherDEA
AZZ162079Medicare PIN
AZZ162075Medicare PIN
AZZ164138Medicare PIN
AZZ164141Medicare PIN
AZZ164137Medicare PIN
AZZ162074Medicare PIN
AZZ162076Medicare PIN
AZMP0015986OtherDEA
AZZ162077Medicare PIN
AZZ162078Medicare PIN
AZZ164142Medicare PIN
AZZ164139Medicare PIN