Provider Demographics
NPI:1437402179
Name:RONALD DOCTOR OD PA
Entity Type:Organization
Organization Name:RONALD DOCTOR OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-927-7805
Mailing Address - Street 1:2300 BEE RIDGE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6268
Mailing Address - Country:US
Mailing Address - Phone:941-927-7805
Mailing Address - Fax:941-927-7808
Practice Address - Street 1:2300 BEE RIDGE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6268
Practice Address - Country:US
Practice Address - Phone:941-927-7805
Practice Address - Fax:941-927-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D86100Medicare UPIN