MEDICARE: DR. RONALD GEOFFREY HAVELOCK 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	MD1074	MD

General Provider Information

NPI Number	:	1013070762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD GEOFFREY HAVELOCK O.D.

Provider Business Mailing Address
First Line	:	3450 FORT MEADE RD
Second Line	:	LAUREL PROFESSIONAL BLD. STE 104
City	:	LAUREL
State	:	MD
Zip	:	20724-2040
Country	:	US
Telephone Number	:	301-483-3323
Fax Number	:	301-483-3345

Provider Business Practice Location Address
First Line	:	3450 FORT MEADE RD
Second Line	:	LAUREL PROFESSIONAL BLD. STE 104
City	:	LAUREL
State	:	MD
Zip	:	20724-2040
Country	:	US
Telephone Number	:	301-483-3323
Fax Number	:	301-483-3345

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

Provider Enumeration Date	:	12/17/2006
Last Update Date	:	07/09/2007

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