Provider Demographics
NPI:1487708723
Name:WINDSOR, RICHARD L (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:WINDSOR
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:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:HARTFORD CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47348-0166
Mailing Address - Country:US
Mailing Address - Phone:765-348-2020
Mailing Address - Fax:765-348-2503
Practice Address - Street 1:315 HUGGINS DR
Practice Address - Street 2:
Practice Address - City:HARTFORD CITY
Practice Address - State:IN
Practice Address - Zip Code:47348-8999
Practice Address - Country:US
Practice Address - Phone:765-348-2020
Practice Address - Fax:765-348-2503
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001619A152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100152600Medicaid
IN410028183OtherRRMC
IN070720DMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE ID
INT92130Medicare UPIN
IN1046420001Medicare NSC