Provider Demographics
NPI:1689639528
Name:FUSS, RICHARD BRADLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRADLEY
Last Name:FUSS
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 1:12615 WATERSPOUT CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1024
Mailing Address - Country:US
Mailing Address - Phone:410-356-9291
Mailing Address - Fax:
Practice Address - Street 1:5006 SINCLAIR LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-5936
Practice Address - Country:US
Practice Address - Phone:410-488-6800
Practice Address - Fax:410-488-4270
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1167152W00000X, 152WC0802X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU36061Medicare UPIN
MD132L-942AMedicare ID - Type Unspecified