MEDICARE: RICHARD ALLEN STATESIR M.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	207W00000X	Ophthalmology Physician	35053677S	OH

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	:	1699778142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ALLEN STATESIR M.D.

Provider Business Mailing Address
First Line	:	14701 DETROIT AVE STE 280
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4109
Country	:	US
Telephone Number	:	216-228-9122
Fax Number	:	216-221-9773

Provider Business Practice Location Address
First Line	:	14701 DETROIT AVE
Second Line	:	STE 280
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4109
Country	:	US
Telephone Number	:	216-228-9122
Fax Number	:	216-221-9773

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

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	09/10/2025

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Directions to “ RICHARD ALLEN STATESIR M.D.” Practice Location

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