Provider Demographics
NPI:1588685044
Name:RICHARDSON, WILLIAM PAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PAYNE
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 1:12185 ALTA MESA DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3577
Mailing Address - Country:US
Mailing Address - Phone:530-401-1063
Mailing Address - Fax:530-653-2045
Practice Address - Street 1:12185 ALTA MESA DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3577
Practice Address - Country:US
Practice Address - Phone:530-401-1063
Practice Address - Fax:530-653-2045
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5588152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0055880Medicaid
CASD0055880Medicare ID - Type Unspecified
CAT10049Medicare UPIN