Provider Demographics
NPI:1083602783
Name:LUCIUS, RICHARD WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:LUCIUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2055 15TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1747
Mailing Address - Country:US
Mailing Address - Phone:320-251-1432
Mailing Address - Fax:320-251-7122
Practice Address - Street 1:2055 15TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1747
Practice Address - Country:US
Practice Address - Phone:320-251-1432
Practice Address - Fax:320-251-7122
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40570207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0807403OtherMEDICA
180033446OtherRAILROAD MEDICARE
MN46Q20LUOtherBLUE CROSS
MN126327700Medicaid
G71107Medicare UPIN
MN46Q20LUOtherBLUE CROSS