Provider Demographics
NPI:1275516262
Name:IRWIN, RICHARD DREW (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DREW
Last Name:IRWIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2507 SAN ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-4525
Mailing Address - Country:US
Mailing Address - Phone:512-472-4498
Mailing Address - Fax:
Practice Address - Street 1:2507 SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4525
Practice Address - Country:US
Practice Address - Phone:512-472-4498
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2842T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T91173Medicare UPIN