Basic Information
| Provider Information | |||||||||
| NPI: | 1538173125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLINE | ||||||||
| FirstName: | RONALD | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 MEMORIAL PKWY | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023684505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819867400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27 MEMORIAL PKWY | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023684505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819867400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2342 | MA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 29047 | 01 | MA | CMSP | OTHER | 00006905 | 01 | MA | BMC | OTHER | 106460 | 01 | UHC | OTHER | 708853 | 01 | MA | TUFTS | OTHER | 0004456 | 01 | MA | NHP | OTHER | 40377 | 01 | AETNA | OTHER | 645248 | 01 | MA | HPHC | OTHER | 0347302 | 05 | MA | MEDICAID | W15043 | 01 | MA | BCBS | OTHER |