Provider Demographics
NPI:1407183098
Name:MARK R RICHARDSON RPH OD PC
Entity Type:Organization
Organization Name:MARK R RICHARDSON RPH OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-443-0340
Mailing Address - Street 1:3103 FM 1960 RD W
Mailing Address - Street 2:SUITE V
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3382
Mailing Address - Country:US
Mailing Address - Phone:281-443-0340
Mailing Address - Fax:281-443-0340
Practice Address - Street 1:3103 FM 1960 RD W
Practice Address - Street 2:SUITE V
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3382
Practice Address - Country:US
Practice Address - Phone:281-443-0340
Practice Address - Fax:281-443-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4204TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty