Provider Demographics
NPI:1700694189
Name:RICHMOND, DAVIS HARLAND
Entity type:Individual
Prefix:
First Name:DAVIS
Middle Name:HARLAND
Last Name:RICHMOND
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 1:2610 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-9109
Mailing Address - Country:US
Mailing Address - Phone:509-293-2716
Mailing Address - Fax:
Practice Address - Street 1:2000 N WENATCHEE AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1056
Practice Address - Country:US
Practice Address - Phone:509-665-9323
Practice Address - Fax:509-665-8822
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO00002130156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician