Provider Demographics
NPI:1245348473
Name:YORK, RICHARD WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WAYNE
Last Name:YORK
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 1:1684 VENTURE DR.
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1990
Mailing Address - Country:US
Mailing Address - Phone:740-393-6010
Mailing Address - Fax:740-393-2320
Practice Address - Street 1:1684 VENTURE DR
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-8950
Practice Address - Country:US
Practice Address - Phone:740-393-6010
Practice Address - Fax:740-393-2320
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3446 / T730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0 398118Medicaid
OHY00469062Medicare ID - Type Unspecified