Provider Demographics
NPI:1386688455
Name:PRICE, RICHARD S (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:PRICE
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 1:152 BAY ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2329
Mailing Address - Country:US
Mailing Address - Phone:518-692-2960
Mailing Address - Fax:518-692-8826
Practice Address - Street 1:ROUTE 29
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834
Practice Address - Country:US
Practice Address - Phone:518-692-2960
Practice Address - Fax:518-692-8826
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0067561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002649636Medicaid
NYRB0174Medicare ID - Type Unspecified
NYU96113Medicare UPIN