MEDICARE: SCOTT JAY RICHTER O.D.

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	VUT 003389	NY

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	:	1083687214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT JAY RICHTER O.D.

Provider Business Mailing Address
First Line	:	338 RUTLAND AVE
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-2841
Country	:	US
Telephone Number	:	201-833-8395
Fax Number	:	201-833-0321

Provider Business Practice Location Address
First Line	:	33 WEST 42ND STREET
Second Line	:	SUNY, COLLEGE OF OPTOMETRY
City	:	NEW YORK CITY
State	:	NY
Zip	:	10036-8005
Country	:	US
Telephone Number	:	212-938-5864
Fax Number	:	212-938-4099

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	12/10/2010

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