Provider Demographics
NPI:1609890797
Name:CASEY, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:CASEY
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:PO BOX 2326
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-7826
Mailing Address - Country:US
Mailing Address - Phone:310-206-5512
Mailing Address - Fax:310-206-9723
Practice Address - Street 1:100 STEIN PLZ
Practice Address - Street 2:RM-1340
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7065
Practice Address - Country:US
Practice Address - Phone:310-206-5512
Practice Address - Fax:310-206-9723
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69608207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G696080OtherMEDI CAL
CA00G696080OtherMEDI CAL
CAWG69608BMedicare ID - Type Unspecified