Provider Demographics
NPI:1336180405
Name:BELL, RICHARD A (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BELL
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:PO BOX 160308
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78280-2508
Mailing Address - Country:US
Mailing Address - Phone:210-366-1199
Mailing Address - Fax:210-349-7111
Practice Address - Street 1:15677 SAN PEDRO
Practice Address - Street 2:B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3732
Practice Address - Country:US
Practice Address - Phone:210-490-9205
Practice Address - Fax:210-490-3633
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3445TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80028EMedicare PIN
T12151Medicare UPIN