Provider Demographics
NPI:1598960585
Name:RICHARDS, REESE JOHN (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:REESE
Middle Name:JOHN
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 5900 S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7379
Mailing Address - Country:US
Mailing Address - Phone:801-266-2020
Mailing Address - Fax:801-268-6602
Practice Address - Street 1:201 E 5900 S
Practice Address - Street 2:SUITE 101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-7379
Practice Address - Country:US
Practice Address - Phone:801-266-2020
Practice Address - Fax:801-268-6602
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
0704130001Medicare NSC