Provider Demographics
NPI:1013216431
Name:RONALD M. CEDRONE OD, LLC
Entity Type:Organization
Organization Name:RONALD M. CEDRONE OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CEDRONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-771-7968
Mailing Address - Street 1:335 MAINE MALL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3214
Mailing Address - Country:US
Mailing Address - Phone:207-771-7968
Mailing Address - Fax:207-771-7983
Practice Address - Street 1:335 MAINE MALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3214
Practice Address - Country:US
Practice Address - Phone:207-771-7968
Practice Address - Fax:207-771-7983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0020827OtherMEDICARE PTAN
MEU31645Medicare UPIN
ME0020827Medicare PIN