Provider Demographics
NPI:1629116025
Name:RICHTER, DENNIS G (OD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:G
Last Name:RICHTER
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:PO BOX 4145
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-4145
Mailing Address - Country:US
Mailing Address - Phone:812-537-2020
Mailing Address - Fax:812-537-1157
Practice Address - Street 1:403 WALNUT ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025
Practice Address - Country:US
Practice Address - Phone:812-537-2020
Practice Address - Fax:812-537-1157
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001692A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000023045OtherANTHEM
IN0692OtherHUMANA
IN100153120AMedicaid
RI437440Medicare ID - Type Unspecified
IN000000023045OtherANTHEM
IN0389420001Medicare NSC