=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568600906
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANCISCO JOSE RICHARDSON O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2009
-----------------------------------------------------
Last Update Date | 09/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2285 ALOMA AVE
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32792-3303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-672-2020
-----------------------------------------------------
Fax | 407-624-4527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2285 ALOMA AVE
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32792-3303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-672-2020
-----------------------------------------------------
Fax | 407-624-4527
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC 4458
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------