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General NPI Number Information
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NPI Number | 1316093651
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Entity Type | Individual
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Provider Name | RICHARD ALLEN KERSHAW O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1333 N CARPENTER RD
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City | BRUNSWICK
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State | OH
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Zip | 44212-3178
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Country | US
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Telephone | 330-273-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 18148 HERITAGE TRL
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City | STRONGSVILLE
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State | OH
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Zip | 44136-7078
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Country | US
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Telephone | 440-238-2363
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Fax |
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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 | 3744
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License Number State | OH
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