Provider Demographics
NPI:1518952530
Name:TALAMO, RICHARD FRANCIS (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FRANCIS
Last Name:TALAMO
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 1:107 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN DAM
Mailing Address - State:PA
Mailing Address - Zip Code:17876-9210
Mailing Address - Country:US
Mailing Address - Phone:570-743-0427
Mailing Address - Fax:570-743-1147
Practice Address - Street 1:109 MONROE ST
Practice Address - Street 2:SUITE 40
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-7672
Practice Address - Country:US
Practice Address - Phone:570-743-0427
Practice Address - Fax:570-743-1147
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET009054152W00000X
PAOE006644P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA72925Medicare UPIN
PATA475397Medicare ID - Type Unspecified