| |
9692 Wolfe Rd, Caledonia, MS 39740-9223 | |
(662) 241-9661 | |
(662) 241-9663 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 9692 Wolfe Rd, Caledonia, Mississippi |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1720403900 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | 871 (Mississippi) | Primary |
Provider Name | Nicholas Thomas Richardson |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1285975094 PECOS PAC ID: 9133346596 Enrollment ID: I20140807001622 |
Mailing Address | Practice Location Address |
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Po Box 418, Caledonia, MS 39740-0418 Ph: (662) 241-9661 | 9692 Wolfe Rd, Caledonia, MS 39740-9223 Ph: (662) 241-9661 |
Dr. Nicholas Thomas Richardson, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 9692 Wolfe Rd, Caledonia, MS 39740 Phone: 662-241-9661 Fax: 662-241-9663 |