MEDICARE: DR. RONALD EUGENE MCCORD OD

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	OPC 002078	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295728053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD EUGENE MCCORD OD

Provider Business Mailing Address
First Line	:	PO BOX 1464
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34958-1464
Country	:	US
Telephone Number	:	772-335-2209
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 SE TIFFANY AVE
Second Line	:	STE 105
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-7576
Country	:	US
Telephone Number	:	772-335-2209
Fax Number	:	772-337-9177

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/15/2010

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