Provider Demographics
NPI:1922071612
Name:NORMAN, RICHARD A (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:NORMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:A
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:4671 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3817
Mailing Address - Country:US
Mailing Address - Phone:954-434-4671
Mailing Address - Fax:954-434-4556
Practice Address - Street 1:4671 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-434-4671
Practice Address - Fax:954-434-4556
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-11
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1492152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078141000Medicaid
FL078141000Medicaid
FL19223Medicare ID - Type Unspecified