Provider Demographics
NPI:1558929406
Name:NORMAN, RONALD DALE JR (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DALE
Last Name:NORMAN
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-396-4893
Practice Address - Street 1:345 CLYDE MORRIS BLVD STE 330
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3114
Practice Address - Country:US
Practice Address - Phone:386-206-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC5670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist