Provider Demographics
NPI:1558368100
Name:MORTON, RICHARD W (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:MORTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S PANTOPS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8672
Mailing Address - Country:US
Mailing Address - Phone:434-977-5160
Mailing Address - Fax:434-977-5202
Practice Address - Street 1:110 S PANTOPS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8672
Practice Address - Country:US
Practice Address - Phone:434-977-5160
Practice Address - Fax:434-977-5202
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-01-21
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
VA0101038523207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA112180OtherANTHEM BLUE CROSS
VA112180OtherANTHEM BLUE CROSS