Provider Demographics
NPI:1346240512
Name:RICHARDSON, TODD L (OD)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:L
Last Name:RICHARDSON
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 1:12116 SE MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6000
Mailing Address - Country:US
Mailing Address - Phone:360-892-3828
Mailing Address - Fax:360-254-0576
Practice Address - Street 1:12116 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6000
Practice Address - Country:US
Practice Address - Phone:360-892-3828
Practice Address - Fax:360-254-0576
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261010D00001257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2056406 /WA1257Medicaid
WA2056406 /WA1257Medicaid
WAT60989Medicare UPIN