MEDICARE: DAVID D. RICHARDSON, M.D., INC.

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	207W00000X	Ophthalmology Physician	A62824	CA

General Provider Information

NPI Number	:	1407984891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID D. RICHARDSON, M.D., INC.

Provider Business Mailing Address
First Line	:	2020 HUNTINGTON DR
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2022
Country	:	US
Telephone Number	:	626-289-7856
Fax Number	:	626-284-6532

Provider Business Practice Location Address
First Line	:	2020 HUNTINGTON DR
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2022
Country	:	US
Telephone Number	:	626-289-7856
Fax Number	:	626-284-6532

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DAVID D. RICHARDSON
Credential	:	M.D.
Telephone Number	:	626-289-7856

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	02/16/2015

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