Provider Demographics
NPI:1376688507
Name:SYLVESTER, RICHARD A (OD,MAT,PA)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:OD,MAT,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:1650 N LAKE FOREST DR STE 100
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7668
Practice Address - Country:US
Practice Address - Phone:972-369-1411
Practice Address - Fax:972-369-1197
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7005346152W00000X, 152WL0500X, 152WP0200X, 152WS0006X, 152WX0102X, 332H00000X, 332H00000X
TX5346152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No332H00000XSuppliersEyewear Supplier