Provider Demographics
NPI:1285517961
Name:RONTO, ELICIA RENEE
Entity type:Individual
Prefix:
First Name:ELICIA
Middle Name:RENEE
Last Name:RONTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 E LAKE RD BUILDING 2D
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16531-0001
Mailing Address - Country:US
Mailing Address - Phone:814-875-3169
Mailing Address - Fax:
Practice Address - Street 1:2901 E LAKE RD BUILDING 2D
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16531-0001
Practice Address - Country:US
Practice Address - Phone:814-875-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA238325156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician