Provider Demographics
NPI:1033105515
Name:DOUGLAS, RICHARD N (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:N
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10431 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-5101
Mailing Address - Country:US
Mailing Address - Phone:804-217-6363
Mailing Address - Fax:804-217-6400
Practice Address - Street 1:10431 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-5101
Practice Address - Country:US
Practice Address - Phone:804-217-6363
Practice Address - Fax:804-217-6400
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601002308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010001803Medicaid
VAU94802Medicare UPIN
VA010001803Medicaid