Provider Demographics
NPI:1528017399
Name:BLACK, RICHARD L (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:BLACK
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 1:133 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7947
Mailing Address - Country:US
Mailing Address - Phone:919-779-1500
Mailing Address - Fax:919-779-5015
Practice Address - Street 1:133 GLEN RD
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7947
Practice Address - Country:US
Practice Address - Phone:919-779-1500
Practice Address - Fax:919-779-5015
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 1312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1013032739OtherLOCATION NPI