NPIMap

Organization Active NPI

Richardson Eye Clinic, PLLC

  • Optometrist
  • Vancouver, WA
National Provider Identifier
1942655246
Registry record updated Apr 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
RICHARDSON EYE CLINIC, PLLC
Practice address
12116 SE Mill Plain Blvd Ste 1
Vancouver, WA 98684-6000
Phone
(360) 892-3828
Fax
(360) 254-0576
NPI assigned
Apr 25, 2016
Last updated
Apr 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2016

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

Authorized official

Name
Dr. Todd L Richardson, ODNPI 1346240512
Title
Owner
Phone
(360) 892-3828

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

12116 SE Mill Plain Blvd Ste 1
Vancouver, WA 98684-6000

Mailing address

12116 SE Mill Plain Blvd Ste 1
Vancouver, WA 98684-6000
Phone (360) 892-3828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160830002518 WA Part B Supplier - Clinic/Group Practice 6305132390 Receives reassigned benefits from 1 practitioner
Practice locations: Vancouver, WA

National Provider Directory

National Provider Directory

Locations

12116 SE Mill Plain Blvd
Ste 1
Vancouver, WA 98684
Phone (360) 892-3828

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1461542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461542400000",
    "number": "1942655246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12116 SE MILL PLAIN BLVD STE 1",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846000",
            "telephone_number": "360-892-3828",
            "fax_number": "360-254-0576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12116 SE MILL PLAIN BLVD STE 1",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846000",
            "telephone_number": "360-892-3828",
            "fax_number": "360-254-0576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARDSON EYE CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-25",
        "last_updated": "2016-04-25",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-892-3828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.