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General NPI Number Information
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NPI Number | 1598094971
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Entity Type | Organization
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Legal Business Name | CHARLES A. RICHARDS, O.D.
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 17151 MAIN ST STE C
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City | HESPERIA
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State | CA
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Zip | 92345-6191
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Country | US
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Telephone | 760-244-4904
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Fax | 760-244-7804
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Provider Business Mailing Address
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Address Line | 17151 MAIN ST STE C
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City | HESPERIA
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State | CA
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Zip | 92345-6191
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Country | US
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Telephone | 760-244-4904
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Fax | 760-244-7804
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES A. RICHARDS
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Credential | O.D.
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Telephone | 760-244-4904
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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 | OPT6330TPL
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License Number State | CA
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