Provider Demographics
NPI:1154478642
Name:RICHWOOD VISION CENTER
Entity Type:Organization
Organization Name:RICHWOOD VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIEDERKOHR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-943-2148
Mailing Address - Street 1:8 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43344-1132
Mailing Address - Country:US
Mailing Address - Phone:740-943-2148
Mailing Address - Fax:740-943-2148
Practice Address - Street 1:8 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43344-1132
Practice Address - Country:US
Practice Address - Phone:740-943-2148
Practice Address - Fax:740-943-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3083152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0443569Medicaid
OH0443569Medicaid
OH0306387Medicare UPIN