Provider Demographics
NPI:1073683371
Name:SURDIN, RONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:SURDIN
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 1:106 CHARTLEY PARK DRIVE
Mailing Address - Street 2:106
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136
Mailing Address - Country:US
Mailing Address - Phone:410-833-6622
Mailing Address - Fax:410-526-9828
Practice Address - Street 1:106 CHARTLEY PARK DRIVE
Practice Address - Street 2:106
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136
Practice Address - Country:US
Practice Address - Phone:410-833-6622
Practice Address - Fax:410-526-9828
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT60010Medicare UPIN