Provider Demographics
NPI:1932312063
Name:FOULKES, RICHARD BRIAN (MD,)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRIAN
Last Name:FOULKES
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6857 CAMROSE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-3100
Mailing Address - Country:US
Mailing Address - Phone:708-955-5678
Mailing Address - Fax:
Practice Address - Street 1:2446 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3041
Practice Address - Country:US
Practice Address - Phone:323-728-5500
Practice Address - Fax:323-728-4408
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086926207W00000X
CAG85290207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG22274Medicare UPIN