Provider Demographics
NPI:1326157207
Name:BLACKWELL, RICHARD H (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:BLACKWELL
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 1:700 HAYWOOD RD STE 227
Mailing Address - Street 2:HAYWOOD MALL
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6133
Mailing Address - Country:US
Mailing Address - Phone:864-234-5350
Mailing Address - Fax:864-234-5352
Practice Address - Street 1:700 HAYWOOD RD STE 227
Practice Address - Street 2:HAYWOOD MALL
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6133
Practice Address - Country:US
Practice Address - Phone:864-234-5350
Practice Address - Fax:864-234-5352
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC0706OtherEYEMED
SCSC0706OtherEYEMED
SCU06069Medicare UPIN