Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 991DTKY | KY |
NPI | 1003904004 |
---|---|
Provider Name | Dr. Donald L Richardson |
First Address | Somerset, KY 42503-1701 |
Second Address | Somerset, KY 42503-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
77009918 | (05) | KY |
9213501 | MEDICARE (01) | KY |
T54706 | (02) | KY |