Provider Demographics
NPI:1275668519
Name:RICHARDS, LIONEL D JR (OD)
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:D
Last Name:RICHARDS
Suffix:JR
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 1:2300 S CONGRESS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-7400
Mailing Address - Country:US
Mailing Address - Phone:561-742-1944
Mailing Address - Fax:561-742-0525
Practice Address - Street 1:2300 S CONGRESS AVE STE 102
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7400
Practice Address - Country:US
Practice Address - Phone:561-742-1944
Practice Address - Fax:561-742-0525
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084843300Medicaid
FLK7231Medicare ID - Type Unspecified
FL084843300Medicaid