MEDICARE: DR. LAVERDA MONIQUE RICHARDS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	13-0001387	DE
2	152W00000X	Optometrist	OL-049	GU
3	152W00000X	Optometrist	OE008223T	PA

General Provider Information

NPI Number	:	1497959456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAVERDA MONIQUE RICHARDS O.D.

Provider Business Mailing Address
First Line	:	1316 W CHESTER PIKE APT C7
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-6435
Country	:	US
Telephone Number	:	610-761-4760
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 W CHELTENHAM AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1003
Country	:	US
Telephone Number	:	215-885-1200
Fax Number	:	215-885-8807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	07/13/2021

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