MEDICARE: DR. RONALD B. MORI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5184	CA

General Provider Information

NPI Number	:	1154407278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD B. MORI O.D.

Provider Business Mailing Address
First Line	:	4617 FREEPORT BLVD
Second Line	:	SUITE D
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-2015
Country	:	US
Telephone Number	:	916-452-4439
Fax Number	:	916-452-3432

Provider Business Practice Location Address
First Line	:	4617 FREEPORT BLVD
Second Line	:	SUITE D
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-2015
Country	:	US
Telephone Number	:	916-452-4439
Fax Number	:	916-452-3432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/30/2008

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