Provider Demographics
NPI:1205830551
Name:STENDER, RICHARD B (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:STENDER
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 1:624 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:SISTERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26175-1324
Mailing Address - Country:US
Mailing Address - Phone:304-652-2459
Mailing Address - Fax:304-652-2459
Practice Address - Street 1:624 WELLS ST
Practice Address - Street 2:
Practice Address - City:SISTERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26175-1324
Practice Address - Country:US
Practice Address - Phone:304-652-2459
Practice Address - Fax:304-652-2459
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV607OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150469000Medicaid
WV550548934-001OtherMS-BC-BS
WV221907OtherCARELINK HEALTH PLANS
WV55-0548934-00000OtherCORE SOURCE
WVH00607OtherTHE HEALTH PLAN
WV1021406OtherWV WORKERS COMP.
WV0590200001Medicare NSC
WVST9156553Medicare PIN
WV221907OtherCARELINK HEALTH PLANS