Provider Demographics
NPI:1689732430
Name:RICHTER, GEORGE WILLIAM JR (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:RICHTER
Suffix:JR
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 1:450 E MAIN ST
Mailing Address - Street 2:DOCTORS PARK
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1581
Mailing Address - Country:US
Mailing Address - Phone:330-533-5333
Mailing Address - Fax:
Practice Address - Street 1:450 E MAIN ST
Practice Address - Street 2:DOCTORS PARK
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1581
Practice Address - Country:US
Practice Address - Phone:330-533-5333
Practice Address - Fax:330-533-4797
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3887152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRIO592901Medicare ID - Type Unspecified
OHT-80694Medicare UPIN
OHH083210Medicare PIN
OH410012351Medicare PIN
OH0412100001Medicare NSC