Provider Demographics
NPI:1760585327
Name:RICHARD'S SON OPTOMETRIC
Entity Type:Organization
Organization Name:RICHARD'S SON OPTOMETRIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:NATHANIAL
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-414-1548
Mailing Address - Street 1:PO BOX 1905
Mailing Address - Street 2:4141 PEARL RD
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:49256
Mailing Address - Country:US
Mailing Address - Phone:330-723-0234
Mailing Address - Fax:330-723-1608
Practice Address - Street 1:4141 PEARL RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:49256
Practice Address - Country:US
Practice Address - Phone:330-723-0234
Practice Address - Fax:330-723-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4075152W00000X
OHT2168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U56847Medicare UPIN