Provider Demographics
NPI:1942204615
Name:JOHNS, RICHARD E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:JOHNS
Suffix:JR
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 1:106 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-8048
Mailing Address - Country:US
Mailing Address - Phone:304-422-2702
Mailing Address - Fax:304-485-3373
Practice Address - Street 1:106 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-8048
Practice Address - Country:US
Practice Address - Phone:304-422-2702
Practice Address - Fax:304-485-3373
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12687207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVJO0513601Medicare ID - Type Unspecified
WVA72186Medicare UPIN