=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538753363
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DON RICHARDSON,PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2021
-----------------------------------------------------
Last Update Date | 01/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 246 POPLAR AVE STE 1
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42503-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-679-8469
-----------------------------------------------------
Fax | 606-678-8891
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 246 POPLAR AVE STE 1
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42503-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-679-8469
-----------------------------------------------------
Fax | 606-678-8891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DONALD LYNN RICHARDSON
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 606-679-5588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------