Provider Demographics
NPI:1013070762
Name:HAVELOCK, RONALD GEOFFREY (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GEOFFREY
Last Name:HAVELOCK
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:3450 FORT MEADE RD
Mailing Address - Street 2:LAUREL PROFESSIONAL BLD. STE 104
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2040
Mailing Address - Country:US
Mailing Address - Phone:301-483-3323
Mailing Address - Fax:301-483-3345
Practice Address - Street 1:3450 FORT MEADE RD
Practice Address - Street 2:LAUREL PROFESSIONAL BLD. STE 104
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2040
Practice Address - Country:US
Practice Address - Phone:301-483-3323
Practice Address - Fax:301-483-3345
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDMD1074152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2200098Medicare UPIN