Healthcare Provider Details

I. General information

NPI: 1063416543
Provider Name (Legal Business Name): RONALD E MONACELLI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S RIDGEWOOD AVE
DAYTONA BEACH FL
32114-5331
US

IV. Provider business mailing address

701 S RIDGEWOOD AVE
DAYTONA BEACH FL
32114-5331
US

V. Phone/Fax

Practice location:
  • Phone: 386-253-5999
  • Fax: 386-258-3973
Mailing address:
  • Phone: 386-253-5999
  • Fax: 386-258-3973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: