Provider Demographics
NPI:1255321352
Name:JAMISON, RICHARD R (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:JAMISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 ERIE CANAL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4601
Mailing Address - Country:US
Mailing Address - Phone:585-225-5883
Mailing Address - Fax:585-225-8902
Practice Address - Street 1:90 ERIE CANAL DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4601
Practice Address - Country:US
Practice Address - Phone:585-225-5883
Practice Address - Fax:585-225-8902
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105740207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010105740OtherBLUE CHOICE
NY00453961Medicaid
NY00453961Medicaid
NY181015002Medicare ID - Type UnspecifiedRAILROAD MCARE
C58171Medicare UPIN