Provider Demographics
NPI:1043312499
Name:MERRILL, RICHARD HENRY (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HENRY
Last Name:MERRILL
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:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1214
Mailing Address - Country:US
Mailing Address - Phone:334-222-6632
Mailing Address - Fax:334-222-9828
Practice Address - Street 1:406 E THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-3166
Practice Address - Country:US
Practice Address - Phone:334-222-6632
Practice Address - Fax:334-222-9828
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-361-TA-258152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0483050001OtherCIGNA GOVERNMENT SERVICES
AL0483050001Medicare NSC