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Individual
RONALD V. BLACK
Active
Individual
RONALD V. BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT9869T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306035118
—
CA
01
—
1821032442
NPI
CA
01
—
6191070001
DME MACS PTAN
CA
01
—
OPT9869T
OPTOMETRY LICENSE
CA
Enumeration date
06/15/2006
Last updated
09/21/2009
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