Healthcare Provider Details

I. General information

NPI: 1447232806
Provider Name (Legal Business Name): SCOTT C RICHARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7747 W JEFFERSON BLVD SUITE A
FORT WAYNE IN
46804
US

IV. Provider business mailing address

PO BOX 549
WABASH IN
46992-0549
US

V. Phone/Fax

Practice location:
  • Phone: 260-459-8444
  • Fax: 260-459-8443
Mailing address:
  • Phone: 260-569-9550
  • Fax: 260-569-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number01071002A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: