Individual
LAWRENCE E RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2501
(928) 283-2677
Mailing address
PO BOX 600, 167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2748
(928) 283-2677
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T02983
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420357
—
AZ
Enumeration date
06/13/2006
Last updated
06/28/2011
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