MEDICARE: DR. RONALD WAYNE RICHARDSON 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	2000161497	MO
2	152W00000X	Optometrist	046006567	IL
3	152W00000X	Optometrist	7506TG	TX

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568431047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD WAYNE RICHARDSON O.D.

Provider Business Mailing Address
First Line	:	4000 N 10TH ST STE C
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-3048
Country	:	US
Telephone Number	:	217-552-8655
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 N 10TH ST STE C
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-3048
Country	:	US
Telephone Number	:	956-992-0983
Fax Number	:

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	05/27/2021

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Directions to “ DR. RONALD WAYNE RICHARDSON O.D.” Practice Location

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