Provider Demographics
NPI:1700075751
Name:RICHARD D. CREED O.D. PC
Entity Type:Organization
Organization Name:RICHARD D. CREED O.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:CREED
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-687-7530
Mailing Address - Street 1:3705 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2142
Mailing Address - Country:US
Mailing Address - Phone:918-687-7530
Mailing Address - Fax:918-687-4019
Practice Address - Street 1:3705 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2142
Practice Address - Country:US
Practice Address - Phone:918-687-7530
Practice Address - Fax:918-687-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0777760001Medicare NSC
OK800522041Medicare PIN