Healthcare Provider Details

I. General information

NPI: 1457554610
Provider Name (Legal Business Name): MICHAEL S RICHEY, OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 NORTH AVE
SPEARFISH SD
57783-1218
US

IV. Provider business mailing address

1710 NORTH AVE
SPEARFISH SD
57783-1218
US

V. Phone/Fax

Practice location:
  • Phone: 605-642-8480
  • Fax: 605-642-8185
Mailing address:
  • Phone: 605-642-8480
  • Fax: 605-642-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number450
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number502
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code156FX1202X
TaxonomyOptometric Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number450
License Number StateSD

VIII. Authorized Official

Name: MICHAEL S RICHEY
Title or Position: OWNER
Credential: OD
Phone: 605-642-8480