Healthcare Provider Details

I. General information

NPI: 1174588859
Provider Name (Legal Business Name): C. ERIC RICHARDSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 ANDERSON ST
BELTON SC
29627-1945
US

IV. Provider business mailing address

PO BOX 400
BELTON SC
29627-0400
US

V. Phone/Fax

Practice location:
  • Phone: 864-338-5362
  • Fax: 864-338-4388
Mailing address:
  • Phone: 864-338-5362
  • Fax: 864-338-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0555
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: