Provider Demographics
NPI:1063416543
Name:MONACELLI, RONALD E (OD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:MONACELLI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5331
Mailing Address - Country:US
Mailing Address - Phone:386-253-5999
Mailing Address - Fax:386-258-3973
Practice Address - Street 1:701 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5331
Practice Address - Country:US
Practice Address - Phone:386-253-5999
Practice Address - Fax:386-258-3973
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010003472OtherBLUE CHOICE NUMBER
NY00455674Medicaid
NY101942CSOtherPREFERRED CARE NUMBER
NYP010003472OtherBCBS NUMBER
NY580002353OtherRAILROAD MEDICARE
NYP010003472OtherBCBS NUMBER
NY101942CSOtherPREFERRED CARE NUMBER