Provider Demographics
NPI:1215928924
Name:AMES, RICHARD E
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:AMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 BOWEN ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2357
Mailing Address - Country:US
Mailing Address - Phone:920-235-5530
Mailing Address - Fax:920-235-6406
Practice Address - Street 1:1951 BOWEN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2357
Practice Address - Country:US
Practice Address - Phone:920-235-5530
Practice Address - Fax:920-235-6406
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1397-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0202230001Medicare NSC
T61357Medicare UPIN