Provider Demographics
NPI:1407801699
Name:MARQUARDT, RICHARD FOSTER (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FOSTER
Last Name:MARQUARDT
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 1:466 S TRIMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3416
Mailing Address - Country:US
Mailing Address - Phone:419-756-8000
Mailing Address - Fax:419-756-7100
Practice Address - Street 1:466 S TRIMBLE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3416
Practice Address - Country:US
Practice Address - Phone:419-756-8000
Practice Address - Fax:419-756-7100
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4862152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2201089OtherUNITED HEALTHCARE
OH341171920009OtherCIGNA
OH5572538OtherAETNA
OH000000128145OtherANTHEM BC/BS
OH2017767Medicaid
OH410034803OtherRAIL ROAD MEDICARE
OH2017767Medicaid
OH000000128145OtherANTHEM BC/BS