1235223496 NPI number — DR. RONALD DENNIS ROY O.D.

Table of content: JACQUELINE GARCIA (NPI 1992668305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235223496 NPI number — DR. RONALD DENNIS ROY O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROY
Provider First Name:
RONALD
Provider Middle Name:
DENNIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235223496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
890 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04073-3572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-324-0400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
890 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04073-3572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-324-0400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT 594 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 012-899-0001 . This is a "DMERC EYE AND EYEGLASSES" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: OPT 594 . This is a "OPTOMETRY LICENSE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: E003463 . This is a "TRICARE EYE AND VISION" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 3222448 . This is a "AETNA EYE AND VISION" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".