Provider Demographics
NPI:1417104670
Name:MICHELSEN, RICHARD J (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:MICHELSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2580 OLD 1ST ST
Mailing Address - Street 2:SUITE 425
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-2055
Mailing Address - Country:US
Mailing Address - Phone:925-449-8188
Mailing Address - Fax:925-449-1818
Practice Address - Street 1:2999 REGENT STREET
Practice Address - Street 2:SUITE 425
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2119
Practice Address - Country:US
Practice Address - Phone:510-548-6630
Practice Address - Fax:510-548-9765
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA13574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist