MEDICARE: DR. RICHARD N DOUGLAS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0601002308	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033105515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD N DOUGLAS OD

Provider Business Mailing Address
First Line	:	10431 PATTERSON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-5101
Country	:	US
Telephone Number	:	804-217-6363
Fax Number	:	804-217-6400

Provider Business Practice Location Address
First Line	:	10431 PATTERSON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-5101
Country	:	US
Telephone Number	:	804-217-6363
Fax Number	:	804-217-6400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	05/16/2013

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