Provider Demographics
NPI:1841360328
Name:HOM, RICHARD (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:HOM
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 1:3875 W BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0795
Mailing Address - Country:US
Mailing Address - Phone:800-492-4227
Mailing Address - Fax:
Practice Address - Street 1:4038 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9306
Practice Address - Country:US
Practice Address - Phone:800-492-4227
Practice Address - Fax:833-646-0167
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5879152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058790Medicaid
CAT10152Medicare UPIN
CASD0058790Medicaid