Individual provider Active NPI

Lawrence E Richardson, O.D.

  • Optometrist
  • Tuba City, AZ
National Provider Identifier
1659314359
Registry record updated Jun 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
T02983 Issued in MO
Practice address
167 North Main Street
Tuba City, AZ 86045-0600
Phone
(928) 283-2501
Fax
(928) 283-2677
NPI assigned
Jun 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X T02983 MO Primary

Addresses

Primary practice location

167 North Main Street
Tuba City, AZ 86045-0600

Mailing address

PO Box 600
167 North Main Street
Tuba City, AZ 86045-0600
Phone (928) 283-2748

Other identifiers 1

IdentifierTypeStateIssuer
420357MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AZ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100810000632 TX Practitioner - Optometry 0547394777 Reassigns benefits to 1 organization
I20170418001951 AZ Practitioner - Optometry 0547394777 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
77.59 of 100Reported as group
Quality
47.51
Promoting interoperability
69
Improvement activities
40
Cost
86.96

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
T02983MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Flagstaff Eye Care PLLC Optometrist CurrentSince Mar 7, 2017 Accepting new patients
Tuba City Regional Health Care Corporation CurrentSince Jun 9, 2022 Accepting new patients
Tuba City Regional Health Care Corporation Current Accepting new patients
Tuba City Regional Health Care Corporation CurrentSince Jun 9, 2022 Accepting new patients

Locations

410 N San Francisco St
Flagstaff, AZ 86001
Phone (602) 774-5093

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309219200000",
    "number": "1659314359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 600",
            "address_2": "167 NORTH MAIN STREET",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "860450600",
            "telephone_number": "928-283-2748",
            "fax_number": "928-283-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 NORTH MAIN STREET",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "860450600",
            "telephone_number": "928-283-2501",
            "fax_number": "928-283-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "LAWRENCE",
        "middle_name": "E",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2011-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420357",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuba City, AZ

Sources for this page

Verify at the official NPI Registry.