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NPI Code Detail

MEDICARE: DR. LEVI RICHARDSON OD

MEDICARE: DR. LEVI RICHARDSON OD
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
1152W00000XOptometristATI4634OR

General Provider Information

NPI Number : 1932839180
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LEVI RICHARDSON OD
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2022
Last Update Date : 06/11/2022

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Directions to “ DR. LEVI RICHARDSON OD” Practice Location

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