Provider Demographics
NPI:1851464291
Name:RICHARDSON, DANIEL D (OD, PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:D
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 COUNTY ROAD 526 E
Mailing Address - Street 2:
Mailing Address - City:SUMTERVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:33585-5179
Mailing Address - Country:US
Mailing Address - Phone:352-793-2512
Mailing Address - Fax:352-793-2445
Practice Address - Street 1:2405 COUNTY ROAD 526 E
Practice Address - Street 2:
Practice Address - City:SUMTERVILLE
Practice Address - State:FL
Practice Address - Zip Code:33585-5179
Practice Address - Country:US
Practice Address - Phone:352-793-2512
Practice Address - Fax:352-793-2445
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPCOO1048152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0915210001Medicare NSC