Provider Demographics
NPI:1063528073
Name:RICHARD SILLS O D P A
Entity type:Organization
Organization Name:RICHARD SILLS O D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SILLS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-437-1844
Mailing Address - Street 1:14821 BEN C PRATT/6 MILE CYPRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4467
Mailing Address - Country:US
Mailing Address - Phone:239-437-1844
Mailing Address - Fax:239-437-1835
Practice Address - Street 1:14821 BEN C PRATT/6 MILE CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4467
Practice Address - Country:US
Practice Address - Phone:239-437-1844
Practice Address - Fax:239-437-1835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1559152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19137BMedicare ID - Type Unspecified
FL19137BMedicare PIN