Provider Demographics
NPI:1871687871
Name:RICHARDSON, BOBBIE
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N DOUGLAS BLVD STE V
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3328
Mailing Address - Country:US
Mailing Address - Phone:405-733-4300
Mailing Address - Fax:
Practice Address - Street 1:101 N DOUGLAS BLVD STE V
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3328
Practice Address - Country:US
Practice Address - Phone:405-733-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician