Provider Demographics
NPI:1083687214
Name:RICHTER, SCOTT JAY (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JAY
Last Name:RICHTER
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 1:338 RUTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2841
Mailing Address - Country:US
Mailing Address - Phone:201-833-8395
Mailing Address - Fax:201-833-0321
Practice Address - Street 1:33 WEST 42ND STREET
Practice Address - Street 2:SUNY, COLLEGE OF OPTOMETRY
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10036-8005
Practice Address - Country:US
Practice Address - Phone:212-938-5864
Practice Address - Fax:212-938-4099
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT 003389152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244528Medicaid
NY146013200OtherEMPLOYER ID NUMBER
NY146013200OtherEMPLOYER ID NUMBER
NYT49108Medicare UPIN