Provider Demographics
NPI:1992815500
Name:RICHEY, MICHAEL S (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:RICHEY
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 1:1710 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783
Mailing Address - Country:US
Mailing Address - Phone:605-642-8480
Mailing Address - Fax:605-642-8185
Practice Address - Street 1:1710 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783
Practice Address - Country:US
Practice Address - Phone:605-642-8480
Practice Address - Fax:605-642-8185
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0076521OtherBLUE CROSS
WY120802100OtherEQUALITY CARE
SD9201880Medicaid
T66680Medicare UPIN
SD9201880Medicaid
SD0076521OtherBLUE CROSS