Provider Demographics
NPI:1952390460
Name:GRAND, RONALD SHERBURNE (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SHERBURNE
Last Name:GRAND
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 1:741 FRONT ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4991
Mailing Address - Country:US
Mailing Address - Phone:407-566-2020
Mailing Address - Fax:407-566-2010
Practice Address - Street 1:741 FRONT ST
Practice Address - Street 2:SUITE 120
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4991
Practice Address - Country:US
Practice Address - Phone:407-566-2020
Practice Address - Fax:407-566-2010
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0001995152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078924100Medicaid
U05941Medicare UPIN
FL078924100Medicaid