Provider Demographics
NPI:1992955017
Name:LOVE, RONALD (RDO)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:LOVE
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SAINT JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4101
Mailing Address - Country:US
Mailing Address - Phone:617-426-6277
Mailing Address - Fax:617-426-1251
Practice Address - Street 1:31 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4101
Practice Address - Country:US
Practice Address - Phone:617-426-6277
Practice Address - Fax:617-426-1251
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5539156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician