Provider Demographics
NPI:1568431047
Name:RICHARDSON, RONALD WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WAYNE
Last Name:RICHARDSON
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 1:4000 N 10TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3048
Mailing Address - Country:US
Mailing Address - Phone:217-552-8655
Mailing Address - Fax:
Practice Address - Street 1:4000 N 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3048
Practice Address - Country:US
Practice Address - Phone:956-992-0983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000161497152W00000X
IL046006567152W00000X
TX7506TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046006567Medicaid
TX308640702Medicaid
IL046006567Medicaid
TX368091ZJSJMedicare PIN