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General NPI Number Information
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NPI Number | 1285079673
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Entity Type | Organization
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Legal Business Name | DR. MARGUERITE RICHARDSON, OD, LLC
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 5600 DURAND AVE
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City | RACINE
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State | WI
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Zip | 53406-5053
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Country | US
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Telephone | 262-554-5711
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Fax | 262-554-9603
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Provider Business Mailing Address
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Address Line | 4412 WOODLAND TRL
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City | STURTEVANT
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State | WI
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Zip | 53177-3058
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. MARGUERITE RICHARDSON
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Credential | OD
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Telephone | 262-880-4733
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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 | 3224-035
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License Number State | WI
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