Provider Demographics
NPI:1669434197
Name:RICHARD, MICHAEL JASON (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JASON
Last Name:RICHARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9 FOX CHASE LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9458
Mailing Address - Country:US
Mailing Address - Phone:919-403-1417
Mailing Address - Fax:919-681-7445
Practice Address - Street 1:3802 ERWIN ROAD
Practice Address - Street 2:DUKE EYE CENTER
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-4224
Practice Address - Fax:919-681-7445
Is Sole Proprietor?:No
Enumeration Date:2006-04-02
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC00875207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2047715Medicare PIN