Provider Demographics
NPI:1619485539
Name:RICHARDSON, ROXANNE WILLIAMS (VISION TEACHER)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:WILLIAMS
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:VISION TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8757 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3737
Mailing Address - Country:US
Mailing Address - Phone:240-737-5100
Mailing Address - Fax:
Practice Address - Street 1:8757 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3737
Practice Address - Country:US
Practice Address - Phone:240-737-5100
Practice Address - Fax:240-737-5100
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, BlindGroup - Single Specialty