Provider Demographics
NPI:1023185774
Name:MORREALE, RONDA RENA (OD)
Entity type:Individual
Prefix:DR
First Name:RONDA
Middle Name:RENA
Last Name:MORREALE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8179
Mailing Address - Country:US
Mailing Address - Phone:321-752-5454
Mailing Address - Fax:321-752-5405
Practice Address - Street 1:1950 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8179
Practice Address - Country:US
Practice Address - Phone:321-752-5454
Practice Address - Fax:321-752-5405
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3053152W00000X
FLOPC 3053152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620353100Medicaid
FL20821Medicare ID - Type Unspecified
FLU63267Medicare UPIN