Healthcare Provider Details

I. General information

NPI: 1295708402
Provider Name (Legal Business Name): LEONARD S RICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PROVIDENCE PARK DRIVE
MOBILE AL
36695-4617
US

IV. Provider business mailing address

601 PROVIDENCE PARK DRIVE
MOBILE AL
36695-4617
US

V. Phone/Fax

Practice location:
  • Phone: 251-650-1000
  • Fax: 251-650-1010
Mailing address:
  • Phone: 251-650-1000
  • Fax: 251-650-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberL05984R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number9336
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: