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General NPI Number Information
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NPI Number | 1518993583
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Entity Type | Individual
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Provider Name | SUZANNAH R RICH O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 4051 NICHOLASVILLE RD INSIDE WAL-MART VISION CTR
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City | LEXINGTON
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State | KY
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Zip | 40503-4432
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Country | US
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Telephone | 859-272-1422
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Fax |
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Provider Business Mailing Address
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Address Line | 1024 N MAIN ST INSIDE WAL-MART VISION CENTER
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-2311
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Country | US
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Telephone | 859-881-5444
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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 | 1355DT
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License Number State | KY
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