Healthcare Provider Details

I. General information

NPI: 1497483002
Provider Name (Legal Business Name): ALLISON ELIZABETH RICHARDSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 07/04/2023
Certification Date: 07/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52883 N MAIN ST
MATTAWAN MI
49071-8309
US

IV. Provider business mailing address

52883 N MAIN ST
MATTAWAN MI
49071-8309
US

V. Phone/Fax

Practice location:
  • Phone: 269-668-5558
  • Fax:
Mailing address:
  • Phone: 269-668-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4901005640
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number4901005640
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005640
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: