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NPI Code Detail

MEDICARE: JOHN MONTE RENALDO OD

MEDICARE: JOHN MONTE RENALDO 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
1152W00000XOptometristOPC962FL

General Provider Information

NPI Number : 1710989603
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN MONTE RENALDO OD
Provider Business Mailing Address
First Line : 12731 NEW BRITTANY BLVD
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-3632
Country : US
Telephone Number : 239-418-0999
Fax Number : 239-274-0773
Provider Business Practice Location Address
First Line : 12731 NEW BRITTANY BLVD
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-3632
Country : US
Telephone Number : 239-418-0999
Fax Number : 239-274-0773
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 07/08/2007

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