Provider Demographics
NPI:1225075591
Name:RICHERT, TAMMY SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:SUE
Last Name:RICHERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:TAMMY
Other - Middle Name:SUE
Other - Last Name:KOEPSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:14760 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2035
Mailing Address - Country:US
Mailing Address - Phone:402-334-9100
Mailing Address - Fax:402-330-4906
Practice Address - Street 1:14760 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2035
Practice Address - Country:US
Practice Address - Phone:402-334-9100
Practice Address - Fax:402-330-4906
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist