Provider Demographics
NPI:1932205853
Name:FLOYD, RICHARD A (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:FLOYD
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 1:415 WOODBURY GLASSBORO RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4559
Mailing Address - Country:US
Mailing Address - Phone:856-589-1288
Mailing Address - Fax:
Practice Address - Street 1:415 WOODBURY GLASSBORO RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4559
Practice Address - Country:US
Practice Address - Phone:856-589-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00487700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6189202Medicaid
NJU26969Medicare UPIN
NJ544110CAWMedicare ID - Type Unspecified
NJ0636270001Medicare NSC
NJ543791Medicare PIN