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General NPI Number Information
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NPI Number | 1003904004
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Entity Type | Individual
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Provider Name | DONALD L RICHARDSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 246 POPLAR AVE SUITE 1
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City | SOMERSET
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State | KY
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Zip | 42503-1701
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Country | US
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Telephone | 606-679-5588
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Fax | 606-677-9394
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Provider Business Mailing Address
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Address Line | 246 POPLAR AVE SUITE 1
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City | SOMERSET
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State | KY
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Zip | 42503-1701
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Country | US
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Telephone | 606-679-5588
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Fax | 606-677-9394
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 991DTKY
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License Number State | KY
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