Provider Demographics
NPI:1982671988
Name:RICHTER, JAMES RAYOHL II (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RAYOHL
Last Name:RICHTER
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 SONGBIRD CT
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073-4997
Mailing Address - Country:US
Mailing Address - Phone:920-892-6592
Mailing Address - Fax:920-893-2026
Practice Address - Street 1:2207 SONGBIRD CT
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-4997
Practice Address - Country:US
Practice Address - Phone:920-892-6592
Practice Address - Fax:920-893-2026
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1410-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI385-72200Medicaid
WI385-72200Medicaid
WI047550-0003Medicare ID - Type Unspecified