Basic Information
| Provider Information | |||||||||
| NPI: | 1215973037 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | RONNI | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 VONDERBURG DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136811122 | ||||||||
| FaxNumber: | 8136844924 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 VONDERBURG DR | ||||||||
| Address2: | 101 | ||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136811122 | ||||||||
| FaxNumber: | 8136844924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME0070200 | FL | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0110X | ME70200 | FL | Y |
ID Information
| ID | Type | State | Issuer | Description | 6204971 | 01 | FL | CIGNA | OTHER | 250394801 | 05 | FL | MEDICAID | 2074439 | 01 | FL | AETNA | OTHER | 0805361 | 01 | FL | UNITED HEALTHCARE | OTHER | 250394800 | 05 | FL | MEDICAID |