Healthcare Provider Details

I. General information

NPI: 1174522981
Provider Name (Legal Business Name): RICHARD HARRIS BILLMAN II OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 COLUMBIA ST
JACKSON OH
45640-0831
US

IV. Provider business mailing address

PO 831 201 COLUMBIA STREET
JACKSON OH
45640-0831
US

V. Phone/Fax

Practice location:
  • Phone: 740-286-1419
  • Fax: 740-286-5546
Mailing address:
  • Phone: 740-286-1419
  • Fax: 740-286-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3395
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: