Provider Demographics
NPI:1659679397
Name:JOHN J RONCKA, INC
Entity type:Organization
Organization Name:JOHN J RONCKA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RONCKA
Authorized Official - Suffix:JR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:508-997-9856
Mailing Address - Street 1:583 STATE ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH DART MOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748
Mailing Address - Country:US
Mailing Address - Phone:508-997-9856
Mailing Address - Fax:508-996-4401
Practice Address - Street 1:583 STATE ROAD
Practice Address - Street 2:
Practice Address - City:NORTH DART MOUTH
Practice Address - State:MA
Practice Address - Zip Code:02748
Practice Address - Country:US
Practice Address - Phone:508-997-9856
Practice Address - Fax:508-996-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA#4792156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty