Provider Demographics
NPI:1699466284
Name:RICHARD, ALYSSA JUDELL (OD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JUDELL
Last Name:RICHARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-9501
Mailing Address - Country:US
Mailing Address - Phone:763-486-2609
Mailing Address - Fax:
Practice Address - Street 1:2180 TROOP DR
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4582
Practice Address - Country:US
Practice Address - Phone:320-258-3915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist