Provider Demographics
NPI:1073654125
Name:RONALD G TUCKER OD PA
Entity Type:Organization
Organization Name:RONALD G TUCKER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-584-1893
Mailing Address - Street 1:800 E BAY DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2532
Mailing Address - Country:US
Mailing Address - Phone:727-584-1893
Mailing Address - Fax:727-584-1973
Practice Address - Street 1:800 E BAY DR
Practice Address - Street 2:SUITE G
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2532
Practice Address - Country:US
Practice Address - Phone:727-584-1893
Practice Address - Fax:727-584-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT93963Medicare UPIN
FL20095AMedicare ID - Type Unspecified