Provider Demographics
NPI:1619917655
Name:YORK, RICHARD NORRIS (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NORRIS
Last Name:YORK
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 1:13024 HESPERIA RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8302
Mailing Address - Country:US
Mailing Address - Phone:760-245-5364
Mailing Address - Fax:760-951-2733
Practice Address - Street 1:13024 HESPERIA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8302
Practice Address - Country:US
Practice Address - Phone:760-245-5364
Practice Address - Fax:760-951-2733
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7717T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0077170Medicare ID - Type Unspecified
CA0531570001Medicare NSC
T10581Medicare UPIN