Provider Demographics
NPI:1386633089
Name:CEDRONE, RONALD M (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
Last Name:CEDRONE
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:207-771-7968
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:1268 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2341
Practice Address - Country:US
Practice Address - Phone:803-327-2001
Practice Address - Fax:803-327-9843
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOPT1873152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
70622403OtherMEDICARE PTAN
ME282050099Medicaid
70622403OtherMEDICARE PTAN