Provider Demographics
NPI:1346269560
Name:LODWICK, RICHARD KENNETH (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KENNETH
Last Name:LODWICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BULIFANTS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5709
Mailing Address - Country:US
Mailing Address - Phone:757-564-1907
Mailing Address - Fax:757-564-1913
Practice Address - Street 1:101 BULIFANTS BLVD STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5709
Practice Address - Country:US
Practice Address - Phone:757-564-1907
Practice Address - Fax:757-564-1913
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010050308Medicaid
VA0974810001OtherCIGNA DMERC
76039OtherOPTIMA
VA103481OtherANTHEM
VA410047254OtherRAILROAD MEDICARE
VA103481OtherANTHEM
VA0974810001OtherCIGNA DMERC