Provider Demographics
NPI:1548295983
Name:BUCK, RICHARD (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BUCK
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 1:3499 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-4400
Mailing Address - Country:US
Mailing Address - Phone:901-363-7739
Mailing Address - Fax:901-363-7665
Practice Address - Street 1:3499 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4400
Practice Address - Country:US
Practice Address - Phone:901-363-7739
Practice Address - Fax:901-363-7665
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
35952041Medicare PIN
OTH000Medicare UPIN