Individual
DR. SHAWN CHARLES RICHARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
2500 W A ST, SUITE 202, MOSCOW, ID 83843-6000
(208) 882-4662
Mailing address
2500 W A ST, SUITE 202, MOSCOW, ID 83843-6000
(208) 882-4662
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
49995
CO
207W00000X
Ophthalmology Physician
Primary
M-12529
ID
207W00000X
Ophthalmology Physician
MD60292777
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0299990
L&I
WA
05
—
1598929796
—
WA
01
—
P01110201
RR MEDICARE
WA
Enumeration date
07/16/2008
Last updated
12/28/2016
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