Provider Demographics
NPI:1811291578
Name:RICHARD A NORMAN PA
Entity type:Organization
Organization Name:RICHARD A NORMAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-434-4671
Mailing Address - Street 1:4671 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3817
Mailing Address - Country:US
Mailing Address - Phone:954-434-4671
Mailing Address - Fax:954-434-4556
Practice Address - Street 1:4671 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-434-4671
Practice Address - Fax:954-434-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078141000Medicaid
FL19223OtherMEDICARE
FLEZ869AMedicare Oscar/Certification
FLT84126Medicare UPIN