MEDICARE: MICHAEL S RICHEY, OD PC

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	332B00000X	Durable Medical Equipment & Medical Supplies	450	SD
2	152W00000X	Optometrist	502	SD
3	156FX1202X	Optometric Technician
4	152W00000X	Optometrist	450	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	102520100	OTHER	WY	GROUP NUMBER

General Provider Information

NPI Number	:	1457554610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL S RICHEY, OD PC

Provider Business Mailing Address
First Line	:	1710 NORTH AVE
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-1218
Country	:	US
Telephone Number	:	605-642-8480
Fax Number	:	605-642-8185

Provider Business Practice Location Address
First Line	:	1710 NORTH AVE
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-1218
Country	:	US
Telephone Number	:	605-642-8480
Fax Number	:	605-642-8185

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL S RICHEY
Credential	:	OD
Telephone Number	:	605-642-8480

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	10/20/2010

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