Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2178 | OK |
NPI | 1003884875 |
---|---|
Provider Name | Dr. Lorrie A Richardson |
First Address | Muskogee, OK 74403-3866 |
Second Address | Muskogee, OK 74403-3866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100766360A | (05) | OK |
U60629 | (02) | OK |