Provider Demographics
NPI:1780635441
Name:CONFLITTI, RICHARD THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:THOMAS
Last Name:CONFLITTI
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 1:11301 COMMERCE DR
Mailing Address - Street 2:STE. A
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8200
Mailing Address - Country:US
Mailing Address - Phone:616-895-9550
Mailing Address - Fax:616-892-5166
Practice Address - Street 1:11301 COMMERCE DR
Practice Address - Street 2:STE. A
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8200
Practice Address - Country:US
Practice Address - Phone:616-895-9550
Practice Address - Fax:616-892-5166
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3291304Medicaid
MI3291304Medicaid
U29893Medicare UPIN