Basic Information
| Provider Information | |||||||||
| NPI: | 1053377143 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | STEWART | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32 | ||||||||
| Address2: | WHITE MOUNTAIN EYE CARE, ADMINISTRATION | ||||||||
| City: | ANDOVER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032160032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037356060 | ||||||||
| FaxNumber: | 6035363136 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 BOULDER POINT DRIVE | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032643156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035361284 | ||||||||
| FaxNumber: | 6035363136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 08/16/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | NH6187 | NH | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 81186956 | 05 | NH | MEDICAID | 5813500 | 01 | AETNA | OTHER | 0106956Y0NH02 | 01 | BC ANTHEM | OTHER |