Provider Demographics
NPI:1962494195
Name:DELAY, RICHARD LELAND JR (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LELAND
Last Name:DELAY
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:2929 MOSSROCK
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5110
Mailing Address - Country:US
Mailing Address - Phone:210-377-0350
Mailing Address - Fax:210-377-2982
Practice Address - Street 1:2929 MOSSROCK
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5110
Practice Address - Country:US
Practice Address - Phone:210-377-0350
Practice Address - Fax:210-377-2982
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2011-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX4631 TG152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110596701Medicaid
TX110596701Medicaid
TXU39808Medicare UPIN