Provider Demographics
NPI:1245203850
Name:STRIBLING, RICHARD KENT (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KENT
Last Name:STRIBLING
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 1:14994 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-2616
Mailing Address - Country:US
Mailing Address - Phone:662-773-3494
Mailing Address - Fax:
Practice Address - Street 1:1054 AIRPARK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-3368
Practice Address - Country:US
Practice Address - Phone:601-656-3296
Practice Address - Fax:601-656-8164
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087019Medicaid
MSC00329OtherGROUP
MS410000018Medicare PIN
MSC00329OtherGROUP
MS0408550001Medicare NSC