Provider Demographics
NPI:1255310207
Name:STRAKER, RICHARD M (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:STRAKER
Suffix:
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 1:5823 CALHOUN MEMORIAL HWY
Mailing Address - Street 2:SUITE 2-A
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3874
Mailing Address - Country:US
Mailing Address - Phone:864-855-6571
Mailing Address - Fax:
Practice Address - Street 1:5823 CALHOUN MEMORIAL HWY
Practice Address - Street 2:SUITE 2-A
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3874
Practice Address - Country:US
Practice Address - Phone:864-855-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD04923Medicaid
SCD04923Medicaid