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General NPI Number Information
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NPI Number | 1750761458
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Entity Type | Individual
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Provider Name | EMILY S RICHARDSON O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 511 PALMYRA ST
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City | DIXON
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State | IL
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Zip | 61021
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Country | US
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Telephone | 815-284-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 511 PALMYRA ST
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City | DIXON
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State | IL
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Zip | 61021-1953
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Country | US
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Telephone | 815-284-2020
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Fax | 815-284-8326
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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 | 046.010863
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License Number State | IL
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