Provider Demographics
NPI:1700054129
Name:RICHARD B. MADDEN, O.D.
Entity Type:Organization
Organization Name:RICHARD B. MADDEN, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-323-0337
Mailing Address - Street 1:125 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3311
Mailing Address - Country:US
Mailing Address - Phone:580-323-0337
Mailing Address - Fax:580-323-0330
Practice Address - Street 1:125 S 10TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3311
Practice Address - Country:US
Practice Address - Phone:580-323-0337
Practice Address - Fax:580-323-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1159332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT40548Medicare UPIN