Provider Demographics
NPI:1831194612
Name:PENNY, RICHARD SCOTT (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
Last Name:PENNY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:SCOTT
Other - Last Name:PENNY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1689 N BECHTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1568
Mailing Address - Country:US
Mailing Address - Phone:937-323-1233
Mailing Address - Fax:937-323-2518
Practice Address - Street 1:1689 N BECHTLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1568
Practice Address - Country:US
Practice Address - Phone:937-323-1233
Practice Address - Fax:937-323-2518
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0604701Medicare PIN
OHT48643Medicare UPIN
OH0256480001Medicare NSC
OH0256480001Medicare NSC