MEDICARE: RONALD E MCCORD OD PA

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	OPC002078	FL

General Provider Information

NPI Number	:	1801880521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD E MCCORD OD PA

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	:	772-337-9177

Provider Business Practice Location Address
First Line	:	1696 SE HILLMOOR DR
Second Line	:	STE B
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-7699
Country	:	US
Telephone Number	:	772-335-2209
Fax Number	:	772-337-9177

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD EUGENE MCCORD
Credential	:	OD
Telephone Number	:	772-692-7231

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/22/2020

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Practice Location Address:

1696 SE HILLMOOR DR # TD , STE B
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1992794663 — DR. HARRIS IRA GOLDBERG D.C.
Practice Location Address:

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1427032028 — MRS. GLORY IVELISSE GUERRERO ARNP
Practice Location Address:

1696 SE HILLMOOR DR
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34952-7699

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1639157183 — DR. AARON M SHEVLIN DPM
Practice Location Address:

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1083666325 — GONZALO A ORIA MD
Practice Location Address:

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1407882194 — WOMEN'S HEALTHCARE OF PORT ST LUCIE LLC
Practice Location Address:

1696 SE HILLMOOR DR , SUITE A
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