Provider Demographics
NPI:1003884875
Name:RICHARDSON, LORRIE A (OD)
Entity Type:Individual
Prefix:DR
First Name:LORRIE
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3866
Mailing Address - Country:US
Mailing Address - Phone:918-682-7752
Mailing Address - Fax:918-687-8440
Practice Address - Street 1:742 N YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3866
Practice Address - Country:US
Practice Address - Phone:918-682-7752
Practice Address - Fax:918-687-8440
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100766360AMedicaid
OK100766360AMedicaid
OK242407500Medicare ID - Type Unspecified