Provider Demographics
NPI:1982748158
Name:STRUEMPF, RICHARD WILLIAM (LDO)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:STRUEMPF
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 COBB PKWY S
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6517
Mailing Address - Country:US
Mailing Address - Phone:770-429-1847
Mailing Address - Fax:770-590-7103
Practice Address - Street 1:596 COBB PKWY S
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6517
Practice Address - Country:US
Practice Address - Phone:770-429-1847
Practice Address - Fax:770-590-7103
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1524152W00000X
GA410156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA51408OtherDAVIS VISION
GA101743OtherAVESIS
GA23544OtherSPECTERA
GAGA0410OtherEYEMED