Provider Demographics
NPI:1134128952
Name:WISCOUNT, RICHARD J (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:WISCOUNT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5940 HAMILTON BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9648
Mailing Address - Country:US
Mailing Address - Phone:610-481-9200
Mailing Address - Fax:610-481-0289
Practice Address - Street 1:5940 HAMILTON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9648
Practice Address - Country:US
Practice Address - Phone:610-481-9200
Practice Address - Fax:610-481-0289
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-000496152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWI603715Medicare ID - Type Unspecified
PAT-93003Medicare UPIN