Individual provider Active NPI

Richard Lane Odor, PHD

  • Clinical Psychologist
  • Reynoldsburg, OH
National Provider Identifier
1245411230
Registry record updated Nov 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
4100 Issued in OH
Practice address
7664 Slate Ridge Blvd
Reynoldsburg, OH 43068-8158
Phone
(614) 863-4119
Fax
(614) 863-4040
NPI assigned
Nov 18, 2007
Last updated
Nov 18, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 4100 OH Primary

Addresses

Primary practice location

7664 Slate Ridge Blvd
Reynoldsburg, OH 43068-8158

Mailing address

7664 Slate Ridge Blvd
Reynoldsburg, OH 43068-8158
Phone (614) 863-4119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080212000046 OH Practitioner - Clinical Psychologist 4082797287 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

7664 Slate Ridge Blvd
Reynoldsburg, OH 43068-8158
Phone (614) 863-4119

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
4100OHMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Richard L Odor PHD Inc Clinical CurrentSince Feb 12, 2008 Accepting new patients

Locations

7664 Slate Ridge Blvd
Reynoldsburg, OH 43068
Phone (614) 710-0173

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195344000000",
    "number": "1245411230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7664 SLATE RIDGE BLVD",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430688158",
            "telephone_number": "614-863-4119",
            "fax_number": "614-863-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7664 SLATE RIDGE BLVD",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430688158",
            "telephone_number": "614-863-4119",
            "fax_number": "614-863-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOR",
        "first_name": "RICHARD",
        "middle_name": "LANE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-18",
        "last_updated": "2007-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "4100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reynoldsburg, OH

Sources for this page

Verify at the official NPI Registry.