Healthcare Provider Details

I. General information

NPI: 1154478642
Provider Name (Legal Business Name): RICHWOOD VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 S FRANKLIN ST
RICHWOOD OH
43344-1132
US

IV. Provider business mailing address

8 S FRANKLIN ST
RICHWOOD OH
43344-1132
US

V. Phone/Fax

Practice location:
  • Phone: 740-943-2148
  • Fax: 740-943-2148
Mailing address:
  • Phone: 740-943-2148
  • Fax: 740-943-2148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3083
License Number StateOH

VIII. Authorized Official

Name: DR. DANIEL J NIEDERKOHR
Title or Position: DR
Credential: OD
Phone: 740-943-2148