Provider Demographics
NPI:1154381879
Name:RICHARDSON, JAMES A (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2840 HWY 95
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7792
Mailing Address - Country:US
Mailing Address - Phone:928-758-2020
Mailing Address - Fax:928-758-4544
Practice Address - Street 1:2840 HIWAY 95
Practice Address - Street 2:SUITE 108
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7792
Practice Address - Country:US
Practice Address - Phone:928-758-2020
Practice Address - Fax:928-758-4544
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ192152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ114997OtherPTAN
AZZ125427OtherPTAN
AZ1154381879OtherNPI
AZ1760692768OtherNPI
AZ1760692768OtherNPI