Provider Demographics
NPI:1871591065
Name:HAIRSTON, RICHARD JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSEPH
Last Name:HAIRSTON
Suffix:
Gender:M
Credentials:MD
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 2410
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33779-2410
Mailing Address - Country:US
Mailing Address - Phone:727-581-8706
Mailing Address - Fax:727-586-3743
Practice Address - Street 1:148 13TH ST SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3127
Practice Address - Country:US
Practice Address - Phone:727-581-8706
Practice Address - Fax:727-586-3743
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76446207WX0107X
FLME207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260863400Medicaid
F49848Medicare UPIN
58901ZMedicare PIN