Provider Demographics
NPI:1902886443
Name:REDDER, RONALD LEWIS (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEWIS
Last Name:REDDER
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 N 15TH ST
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4514
Practice Address - Country:US
Practice Address - Phone:903-229-4141
Practice Address - Fax:903-872-5273
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6616TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1752503Medicaid
TX1752503Medicaid
TXV05270Medicare UPIN