1053377143 NPI number — DR. JOHN STEWART RICHARDS MD

Table of content: DR. JOHN STEWART RICHARDS MD (NPI 1053377143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053377143 NPI number — DR. JOHN STEWART RICHARDS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDS
Provider First Name:
JOHN
Provider Middle Name:
STEWART
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053377143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32
Provider Second Line Business Mailing Address:
WHITE MOUNTAIN EYE CARE, ADMINISTRATION
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03216-0032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-735-6060
Provider Business Mailing Address Fax Number:
603-536-3136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 BOULDER POINT DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03264-3156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-536-1284
Provider Business Practice Location Address Fax Number:
603-536-3136
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  NH6187 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 81186956 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5813500 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0106956Y0NH02 . This is a "BC ANTHEM" identifier . This identifiers is of the category "OTHER".




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