Provider Demographics
NPI:1578553921
Name:RICHARDSON, DAVID D (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:RICHARDSON
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 1:2020 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2022
Mailing Address - Country:US
Mailing Address - Phone:626-289-7856
Mailing Address - Fax:626-284-6532
Practice Address - Street 1:2020 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2022
Practice Address - Country:US
Practice Address - Phone:626-289-7856
Practice Address - Fax:626-284-6532
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA062824207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180038511OtherRAILROAD MEDICARE
A62824AOtherUNITED HEALTH CARE
A62824Medicare ID - Type Unspecified
180038511OtherRAILROAD MEDICARE