Healthcare Provider Details

I. General information

NPI: 1609892694
Provider Name (Legal Business Name): JOSEPH J RICHARDS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E CUMBERLAND STREET EYELAND OPTICAL
LEBANON PA
17042
US

IV. Provider business mailing address

905 E CUMBERLAND STREET EYELAND OPTICAL
LEBANON PA
17042
US

V. Phone/Fax

Practice location:
  • Phone: 717-228-2020
  • Fax: 717-228-1776
Mailing address:
  • Phone: 717-228-2020
  • Fax: 717-228-1776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6155T
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: