Provider Demographics
NPI:1073506408
Name:DUROCHER, RICHARD DANIEL (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DANIEL
Last Name:DUROCHER
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 1:4322 HARDING PIKE
Mailing Address - Street 2:STE 214
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2490
Mailing Address - Country:US
Mailing Address - Phone:615-386-3036
Mailing Address - Fax:615-386-6421
Practice Address - Street 1:4322 HARDING PIKE
Practice Address - Street 2:STE 214
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2490
Practice Address - Country:US
Practice Address - Phone:615-386-3036
Practice Address - Fax:615-386-6421
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001727152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3940585Medicaid
TN0823169OtherCIGNA
TN2240532OtherUNITED HEALTHCARE
TN4247110001OtherPALMETTO GBA
TN4006662OtherBLUE CROSS BLUE SHIELD
TN410045983OtherRAILROAD MEDICARE
TN2240532OtherUNITED HEALTHCARE
TN0823169OtherCIGNA