Provider Demographics
NPI:1497959456
Name:RICHARDS, LAVERDA MONIQUE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAVERDA
Middle Name:MONIQUE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 W CHESTER PIKE APT C7
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-6435
Mailing Address - Country:US
Mailing Address - Phone:610-761-4760
Mailing Address - Fax:
Practice Address - Street 1:3212 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1003
Practice Address - Country:US
Practice Address - Phone:215-885-1200
Practice Address - Fax:215-885-8807
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE13-0001387152W00000X
GUOL-049152W00000X
PAOE008223T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA242138TZ1Medicare Oscar/Certification
TN3001753Medicare PIN