Stephen M Richardson, O.D.
Individual provider Active NPI Optometrist · Cookeville, TN
NPI 1801895438 · NPPES record last updated Apr 5, 2023
Key facts
- NPI
- 1801895438
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- ODT-1155 (TN)
- Practice address
- 430 Neal St
Cookeville, TN 38501-0916 - Phone
- (931) 528-6411
- Fax
- (931) 372-0380
- NPI assigned
- Jul 15, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Eye Centers of Tennessee, LLC
Practice addresses (Care Compare)
430 Neal St
Cookeville, TN 38501-0916
Phone (931) 528-6411
Merit-based Incentive Payment System (MIPS)
- Final score
- 0 of 100
- Quality
- 0
- Improvement activities
- 0
- Cost
- 0
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101108000891 | TN | Practitioner - Optometry | 2668548249 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1155 | TN | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Centers of Tennessee, LLC | Optometrist | Current | Accepting new patients |
Locations
430 Neal St
Ste A
Cookeville, TN 38501
Phone (931) 528-6411
430 Neal St
Cookeville, TN 38501
Phone (931) 526-9575
15 Iris Ln
Crossville, TN 38555
Phone (931) 456-2728
Interoperability endpoints
- srichardson@ecotn.intellechartdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | ODT-1155 | TN | Yes |
Addresses
Primary practice location
430 Neal St
Cookeville, TN 38501-0916
Mailing address
430 Neal St
Cookeville, TN 38501-0916
Phone (931) 528-6411
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0095470 | Other | BCBS TN | |
| 3596618 | Medicaid | TN |
Other providers in Cookeville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.