Provider Demographics
NPI:1851352983
Name:TOM, RICHARD (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:TOM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6500 HIRABAYASHI DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4500
Mailing Address - Country:US
Mailing Address - Phone:408-226-8666
Mailing Address - Fax:408-226-2382
Practice Address - Street 1:874C BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2725
Practice Address - Country:US
Practice Address - Phone:408-226-8666
Practice Address - Fax:408-226-2382
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9372T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0093720Medicaid
CASD0093720Medicaid