Provider Demographics
NPI:1215973037
Name:CHEN, RONNI M (MD)
Entity type:Individual
Prefix:DR
First Name:RONNI
Middle Name:M
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 VONDERBURG DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5982
Mailing Address - Country:US
Mailing Address - Phone:813-681-1122
Mailing Address - Fax:813-684-4924
Practice Address - Street 1:403 VONDERBURG DR
Practice Address - Street 2:101
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5982
Practice Address - Country:US
Practice Address - Phone:813-681-1122
Practice Address - Fax:813-684-4924
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070200207W00000X
FLME70200207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6204971OtherCIGNA
FL250394801Medicaid
FL2074439OtherAETNA
FL0805361OtherUNITED HEALTHCARE
FL250394800Medicaid
GA180043034Medicare PIN
31990Medicare ID - Type Unspecified
FL250394800Medicaid
FL31990BMedicare PIN
G08853Medicare UPIN