Provider Demographics
NPI:1518183094
Name:WILLIAM C RICH JR
Entity Type:Organization
Organization Name:WILLIAM C RICH JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:607-844-9477
Mailing Address - Street 1:88 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13053-8500
Mailing Address - Country:US
Mailing Address - Phone:607-844-9477
Mailing Address - Fax:607-844-9478
Practice Address - Street 1:88 NORTH ST
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:NY
Practice Address - Zip Code:13053-8500
Practice Address - Country:US
Practice Address - Phone:607-844-9477
Practice Address - Fax:607-844-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02164496Medicaid