Provider Demographics
NPI:1104867209
Name:NEUENFELDT, RICHARD JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:NEUENFELDT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12830 S SAGINAW ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2415
Mailing Address - Country:US
Mailing Address - Phone:810-695-3500
Mailing Address - Fax:810-695-3502
Practice Address - Street 1:12830 S SAGINAW ST
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2415
Practice Address - Country:US
Practice Address - Phone:810-695-3500
Practice Address - Fax:810-695-3502
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU53097Medicare UPIN
MI0M98510Medicare PIN