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General NPI Number Information
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NPI Number | 1699778142
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Entity Type | Individual
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Provider Name | RICHARD ALLEN STATESIR M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/28/2005
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 14701 DETROIT AVE STE 280
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City | LAKEWOOD
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State | OH
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Zip | 44107-4109
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Country | US
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Telephone | 216-228-9122
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Fax | 216-221-9773
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Provider Business Mailing Address
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Address Line | 14701 DETROIT AVE STE 280
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City | LAKEWOOD
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State | OH
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Zip | 44107-4109
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Country | US
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Telephone | 216-228-9122
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Fax | 216-221-9773
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 35053677S
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License Number State | OH
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