Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1911 | KS |
NPI | 1003183062 |
---|---|
Provider Name | Dr. Nicklaus James Richmond |
First Address | Wichita, KS 67213-3916 |
Second Address | Wichita, KS 67213-3916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2011 |
Last Update Date | 24/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200971550A | (05) | KS |