MEDICARE: DR. RICHARD JAMES NEUENFELDT 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	4901003643	MI

General Provider Information

NPI Number	:	1104867209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JAMES NEUENFELDT O.D.

Provider Business Mailing Address
First Line	:	12830 S SAGINAW ST
Second Line	:	SUITE C
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2415
Country	:	US
Telephone Number	:	810-695-3500
Fax Number	:	810-695-3502

Provider Business Practice Location Address
First Line	:	12830 S SAGINAW ST
Second Line	:	SUITE C
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2415
Country	:	US
Telephone Number	:	810-695-3500
Fax Number	:	810-695-3502

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	05/30/2013

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