MEDICARE: DR. RICHARD ALLEN KERSHAW 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	3744	OH

General Provider Information

NPI Number	:	1316093651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ALLEN KERSHAW O.D.

Provider Business Mailing Address
First Line	:	18148 HERITAGE TRL
Second Line	:
City	:	STRONGSVILLE
State	:	OH
Zip	:	44136-7078
Country	:	US
Telephone Number	:	440-238-2363
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 N CARPENTER RD
Second Line	:
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-3178
Country	:	US
Telephone Number	:	330-273-3333
Fax Number	:

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

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	07/08/2007

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