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NPI Code Detail

MEDICARE: RICHARDSON EYECARE PC

MEDICARE: RICHARDSON EYECARE PC
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1780305797
Entity Type Code : Organization
Provider Name (Legal Business Name) : RICHARDSON EYECARE PC
Provider Business Mailing Address
First Line : 2804 19TH AVE
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-2625
Country : US
Telephone Number : 503-357-2020
Fax Number : 503-357-6995
Provider Business Practice Location Address
First Line : 2804 19TH AVE
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-2625
Country : US
Telephone Number : 503-357-2020
Fax Number : 503-357-6995
Authorized Official
Title or Position : PRESIDENT
Name : DR. LEVI RICHARDSON
Credential : OD
Telephone Number : 801-836-5629
Provider Enumeration Date : 09/07/2022
Last Update Date : 09/07/2022

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Directions to “RICHARDSON EYECARE PC ” Practice Location

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