Provider Demographics
NPI:1609960871
Name:PONDER, CURTIS RAY II (RO,ABOC)
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:RAY
Last Name:PONDER
Suffix:II
Gender:M
Credentials:RO,ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2626
Mailing Address - Country:US
Mailing Address - Phone:401-737-2020
Mailing Address - Fax:
Practice Address - Street 1:200 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4440
Practice Address - Country:US
Practice Address - Phone:401-737-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOP308156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI27367-1OtherBLUE CROSS
RI411619OtherBLUE CHIP
RICP54036Medicaid
RI29681OtherNEIGHBORHOOD HEALTH
RI21-01254OtherUNITED HEALTH
RI27367-1OtherBLUE CROSS