Healthcare Provider Details

I. General information

NPI: 1033105515
Provider Name (Legal Business Name): RICHARD N DOUGLAS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10431 PATTERSON AVE
RICHMOND VA
23238-5101
US

IV. Provider business mailing address

10431 PATTERSON AVE
RICHMOND VA
23238-5101
US

V. Phone/Fax

Practice location:
  • Phone: 804-217-6363
  • Fax: 804-217-6400
Mailing address:
  • Phone: 804-217-6363
  • Fax: 804-217-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0601002308
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: