Provider Demographics
NPI:1912952755
Name:KONRATH, RICHARD GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GEORGE
Last Name:KONRATH
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 1:5131 PAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2415
Mailing Address - Country:US
Mailing Address - Phone:419-472-2929
Mailing Address - Fax:419-475-7908
Practice Address - Street 1:5001 MONROE ST
Practice Address - Street 2:T-2
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3627
Practice Address - Country:US
Practice Address - Phone:419-475-7908
Practice Address - Fax:419-475-7916
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH2570152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH2570OtherEYEMED VISION CARE
OH0153373Medicaid
OH04938OtherPARAMOUNT