MEDICARE: RONALD M. CEDRONE OD, LLC

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	OPT607	ME

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0020827	OTHER	ME	MEDICARE PTAN

General Provider Information

NPI Number	:	1013216431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD M. CEDRONE OD, LLC

Provider Business Mailing Address
First Line	:	335 MAINE MALL RD
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-3214
Country	:	US
Telephone Number	:	207-771-7968
Fax Number	:	207-771-7983

Provider Business Practice Location Address
First Line	:	335 MAINE MALL RD
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-3214
Country	:	US
Telephone Number	:	207-771-7968
Fax Number	:	207-771-7983

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. RONALD MICHAEL CEDRONE
Credential	:	O.D.
Telephone Number	:	207-771-7968

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	08/02/2011

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