Provider Demographics
NPI:1841578119
Name:CLAIBORNE, RICHARD T (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:CLAIBORNE
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 1:3701 EUBANK BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3536
Mailing Address - Country:US
Mailing Address - Phone:505-298-2020
Mailing Address - Fax:
Practice Address - Street 1:3701 EUBANK BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3536
Practice Address - Country:US
Practice Address - Phone:505-298-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3396AT152W00000X
NM652152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist