Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT8748T | CA |
NPI | 1003843087 |
---|---|
Provider Name | Dr. Ronald F Janda |
First Address | Modesto, CA 95350-1692 |
Second Address | Modesto, CA 95350-1692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 14/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U10116 | (02) |