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General NPI Number Information
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NPI Number | 1972799674
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Entity Type | Organization
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Legal Business Name | RONALD O SEVIGNY OD
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 10/08/2009
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Provider Practice Location Address
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Address Line | 210 US 27 N
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City | AVON PARK
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State | FL
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Zip | 33825-3073
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Country | US
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Telephone | 863-453-3850
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Fax | 863-452-1462
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Provider Business Mailing Address
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Address Line | PO BOX 1648
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City | AVON PARK
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State | FL
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Zip | 33826-1648
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Country | US
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Telephone | 863-453-3850
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Fax | 863-452-1462
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD O SEVIGNY
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Credential | OD
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Telephone | 863-453-3850
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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 | OPC1052
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License Number State | FL
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