Provider Demographics
NPI:1114076841
Name:HEMINGWAY, RICHARD LAWRENCE (O D)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:HEMINGWAY
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9302 N MERIDIAN ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1873
Mailing Address - Country:US
Mailing Address - Phone:317-848-8879
Mailing Address - Fax:317-848-7976
Practice Address - Street 1:9302 N MERIDIAN ST
Practice Address - Street 2:SUITE 150
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1873
Practice Address - Country:US
Practice Address - Phone:317-848-8879
Practice Address - Fax:317-848-7976
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002591B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200500510Medicaid
INU54731Medicare UPIN