MEDICARE: DR. RICHARD L. WINDSOR 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	18001619A	IN
2	152WL0500X	Low Vision Rehabilitation Optometrist	18001619A	IN

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
2	410028183	OTHER	IN	RRMC

General Provider Information

NPI Number	:	1487708723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD L. WINDSOR O.D.

Provider Business Mailing Address
First Line	:	PO BOX 166
Second Line	:
City	:	HARTFORD CITY
State	:	IN
Zip	:	47348-0166
Country	:	US
Telephone Number	:	765-348-2020
Fax Number	:	765-348-2503

Provider Business Practice Location Address
First Line	:	315 HUGGINS DR
Second Line	:
City	:	HARTFORD CITY
State	:	IN
Zip	:	47348-8999
Country	:	US
Telephone Number	:	765-348-2020
Fax Number	:	765-348-2503

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	11/19/2010

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