Provider Demographics
NPI:1740660380
Name:GRIFFIN, RICHARD (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GRIFFIN
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 1:6405 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4338
Mailing Address - Country:US
Mailing Address - Phone:352-331-6321
Mailing Address - Fax:352-331-8555
Practice Address - Street 1:6405 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4338
Practice Address - Country:US
Practice Address - Phone:352-331-6321
Practice Address - Fax:352-331-8555
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1225152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist