Provider Demographics
NPI:1528093390
Name:SCHUCK, RICHARD E (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:SCHUCK
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 1:92 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1729
Mailing Address - Country:US
Mailing Address - Phone:859-781-2000
Mailing Address - Fax:859-781-8122
Practice Address - Street 1:92 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1729
Practice Address - Country:US
Practice Address - Phone:859-781-2000
Practice Address - Fax:859-781-8122
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0772DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77007722Medicaid
KYT54747Medicare UPIN
KY77007722Medicaid
KY410018139Medicare PIN
KY0644650002Medicare NSC