Provider Demographics
NPI:1447421235
Name:RICHARDSON, JULIE (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-2422
Mailing Address - Country:US
Mailing Address - Phone:603-543-3216
Mailing Address - Fax:
Practice Address - Street 1:5 GROVE ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2422
Practice Address - Country:US
Practice Address - Phone:603-543-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH51156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30750207Medicaid