Provider Demographics
NPI:1831222850
Name:ANTON, RICHARD J (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:ANTON
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 1:1115 SW 37 ST
Mailing Address - Street 2:PMB 1147
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914
Mailing Address - Country:US
Mailing Address - Phone:239-443-6766
Mailing Address - Fax:239-945-5327
Practice Address - Street 1:1005 W. SUGARLAND HWY
Practice Address - Street 2:WALMART NAT VISION CEN
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440
Practice Address - Country:US
Practice Address - Phone:863-902-9844
Practice Address - Fax:863-902-0038
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLOP0000845152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85136Medicare UPIN