Provider Demographics
NPI:1235223496
Name:ROY, RONALD DENNIS (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DENNIS
Last Name:ROY
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 1:890 MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3572
Mailing Address - Country:US
Mailing Address - Phone:207-324-0400
Mailing Address - Fax:
Practice Address - Street 1:890 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3572
Practice Address - Country:US
Practice Address - Phone:207-324-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT 594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME012-899-0001OtherDMERC EYE AND EYEGLASSES
MEOPT 594OtherOPTOMETRY LICENSE
MEE003463OtherTRICARE EYE AND VISION
ME3222448OtherAETNA EYE AND VISION
ME3222448OtherAETNA EYE AND VISION
ME012-899-0001OtherDMERC EYE AND EYEGLASSES
MEU09876Medicare UPIN