Provider Demographics
NPI:1285845669
Name:JOHN S RICHARDS MD PA
Entity Type:Organization
Organization Name:JOHN S RICHARDS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:603-536-1284
Mailing Address - Street 1:607 TENNEY MOUNTAIN HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-3156
Mailing Address - Country:US
Mailing Address - Phone:603-536-1284
Mailing Address - Fax:
Practice Address - Street 1:607 TENNEY MOUNTAIN HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3156
Practice Address - Country:US
Practice Address - Phone:603-536-1284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006956Medicaid
NH81186956Medicaid
VT0006956Medicaid
NHE41245Medicare UPIN