Provider Demographics
NPI:1558445635
Name:SEVIGNY, RONALD O (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:O
Last Name:SEVIGNY
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:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33826-1648
Mailing Address - Country:US
Mailing Address - Phone:863-453-3850
Mailing Address - Fax:863-452-1462
Practice Address - Street 1:210 US 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-3073
Practice Address - Country:US
Practice Address - Phone:863-453-3850
Practice Address - Fax:863-452-1462
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084527200Medicaid
FL19290XMedicare PIN
FLT84042Medicare UPIN
FL1152360001Medicare NSC