Provider Demographics
NPI:1164579710
Name:RICHARDS, JAMES P (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:RICHARDS
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 1:555 PAULARINO AVE
Mailing Address - Street 2:R 101
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3202
Mailing Address - Country:US
Mailing Address - Phone:949-364-6625
Mailing Address - Fax:949-365-0936
Practice Address - Street 1:27000 CROWN VALLEY PARKWAY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:714-364-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8118T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU51562Medicare UPIN