Provider Demographics
NPI:1790955607
Name:RICHARD H MERRILL OD
Entity Type:Organization
Organization Name:RICHARD H MERRILL OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-222-6632
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1214
Mailing Address - Country:US
Mailing Address - Phone:334-222-6632
Mailing Address - Fax:
Practice Address - Street 1:406 E THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-3167
Practice Address - Country:US
Practice Address - Phone:334-222-6632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-361-TA-258 AL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0483050001Medicare NSC