MEDICARE: DR. RONALD EUGENE GIDDENS 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	152WC0802X	Corneal and Contact Management Optometrist	FL982	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	:	1942299409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD EUGENE GIDDENS O.D.

Provider Business Mailing Address
First Line	:	1616 S MILITARY TRL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-5612
Country	:	US
Telephone Number	:	561-968-1234
Fax Number	:	561-967-9178

Provider Business Practice Location Address
First Line	:	1616 S MILITARY TRL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-5612
Country	:	US
Telephone Number	:	561-968-1234
Fax Number	:	561-967-9178

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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