Provider Demographics
NPI:1528144656
Name:RICHARDSON, STUART E
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:E
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S MAINE ST
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-3305
Mailing Address - Country:US
Mailing Address - Phone:775-423-4334
Mailing Address - Fax:775-423-1184
Practice Address - Street 1:445 S MAINE ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3305
Practice Address - Country:US
Practice Address - Phone:775-423-4334
Practice Address - Fax:775-423-1184
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV176152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002501830Medicaid
NVT67336Medicare UPIN
NVV$$$$$$$$$Medicare PIN
NVP00808618Medicare PIN
NV002501830Medicaid