Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2468 | MA |
NPI | 1013088137 |
---|---|
Provider Name | Dr. Ronald Richard Ferrucci |
First Address | Milford, MA 01757-2239 |
Second Address | Milford, MA 01757-2239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0332402 | (05) | MA |
11222745 | CAQH (01) | MA |