Provider Demographics
NPI:1972799674
Name:RONALD O SEVIGNY OD
Entity Type:Organization
Organization Name:RONALD O SEVIGNY OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:O
Authorized Official - Last Name:SEVIGNY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:863-453-3850
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001255600Medicaid
FL6171220002Medicare NSC
FLAK770Medicare PIN