Provider Demographics
NPI:1578972378
Name:MCCOY, RICHARD (LDO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 BOY SCOUT DR
Mailing Address - Street 2:UNIT 107
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2127
Mailing Address - Country:US
Mailing Address - Phone:239-931-0136
Mailing Address - Fax:239-931-0910
Practice Address - Street 1:1850 BOY SCOUT DR
Practice Address - Street 2:UNIT 107
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2127
Practice Address - Country:US
Practice Address - Phone:239-931-0136
Practice Address - Fax:239-931-0910
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 1746156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician