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General NPI Number Information
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NPI Number | 1558929406
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Entity Type | Individual
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Provider Name | RONALD DALE NORMAN JR. OD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 345 CLYDE MORRIS BLVD STE 330
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City | ORMOND BEACH
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State | FL
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Zip | 32174-3114
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Country | US
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Telephone | 386-206-8565
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Fax |
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Provider Business Mailing Address
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Address Line | 11945 SAN JOSE BLVD STE 300
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City | JACKSONVILLE
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State | FL
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Zip | 32223-1627
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Country | US
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Telephone | 904-396-1725
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Fax | 904-396-4893
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC5670
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License Number State | FL
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