Provider Demographics
NPI:1962508135
Name:POPE, RICK STEVEN (OD)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:STEVEN
Last Name:POPE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1575 B STREET
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3017
Mailing Address - Country:US
Mailing Address - Phone:510-581-1430
Mailing Address - Fax:510-581-7368
Practice Address - Street 1:1575 B STREET
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3017
Practice Address - Country:US
Practice Address - Phone:510-581-1430
Practice Address - Fax:510-581-7368
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 7311 TPL152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0073110Medicaid
CASD0073110Medicaid
CASD0073111Medicare PIN