Healthcare Provider Details

I. General information

NPI: 1578553921
Provider Name (Legal Business Name): DAVID D. RICHARDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 HUNTINGTON DR
SAN MARINO CA
91108-2022
US

IV. Provider business mailing address

2020 HUNTINGTON DR
SAN MARINO CA
91108-2022
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-7856
  • Fax: 626-284-6532
Mailing address:
  • Phone: 626-289-7856
  • Fax: 626-284-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA062824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: