Provider Demographics
NPI:1376059956
Name:RICHARD L. LOCKWOOD, D.O., INC
Entity Type:Organization
Organization Name:RICHARD L. LOCKWOOD, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-774-3937
Mailing Address - Street 1:616 CENTRAL CTR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2248
Mailing Address - Country:US
Mailing Address - Phone:740-774-3937
Mailing Address - Fax:740-774-4877
Practice Address - Street 1:616 CENTRAL CTR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2248
Practice Address - Country:US
Practice Address - Phone:740-774-3937
Practice Address - Fax:740-774-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004327207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0666202Medicaid