Provider Demographics
NPI:1801880521
Name:RONALD E MCCORD OD PA
Entity type:Organization
Organization Name:RONALD E MCCORD OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:772-692-7231
Mailing Address - Street 1:PO BOX 1464
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34958-1464
Mailing Address - Country:US
Mailing Address - Phone:772-335-2209
Mailing Address - Fax:772-337-9177
Practice Address - Street 1:1696 SE HILLMOOR DR
Practice Address - Street 2:STE B
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7699
Practice Address - Country:US
Practice Address - Phone:772-335-2209
Practice Address - Fax:772-337-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U10974Medicare UPIN
FL20236Medicare ID - Type Unspecified