MEDICARE: DR. RICHARD SODEN OD

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	152WL0500X	Low Vision Rehabilitation Optometrist	3794	NY
2	152WP0200X	Pediatric Optometrist	3794	NY
3	152WV0400X	Vision Therapy Optometrist	3794	NY
4	152W00000X	Optometrist	3794	NY

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

General Provider Information

NPI Number	:	1578566485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD SODEN OD

Provider Business Mailing Address
First Line	:	33 W 42ND ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-8005
Country	:	US
Telephone Number	:	212-938-5761
Fax Number	:	212-938-5831

Provider Business Practice Location Address
First Line	:	33 W 42ND ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-8005
Country	:	US
Telephone Number	:	212-938-5761
Fax Number	:	212-938-5831

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	02/15/2023

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Directions to “ DR. RICHARD SODEN OD” Practice Location

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