Provider Demographics
NPI:1740365212
Name:STELLO, RONALD A (OD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:STELLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LANNY BRIDGES AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-1615
Mailing Address - Country:US
Mailing Address - Phone:901-475-4288
Mailing Address - Fax:
Practice Address - Street 1:201 LANNY BRIDGES AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-1615
Practice Address - Country:US
Practice Address - Phone:901-475-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV616D152W00000X
TNOD0000002574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3590049Medicare PIN