Provider Demographics
NPI:1174522981
Name:BILLMAN, RICHARD HARRIS II (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:HARRIS
Last Name:BILLMAN
Suffix:II
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 831
Mailing Address - Street 2:201 COLUMBIA STREET
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-0831
Mailing Address - Country:US
Mailing Address - Phone:740-286-1419
Mailing Address - Fax:740-286-5546
Practice Address - Street 1:201 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-0831
Practice Address - Country:US
Practice Address - Phone:740-286-1419
Practice Address - Fax:740-286-5546
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3395152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000117713OtherANTHEM INS. CO.
OH310965435026Medicaid
OH310965435026Medicaid
OH410011033Medicare PIN
OH$$$$$$$$$001OtherMEDICAL MUTUAL INS. CO
OHT48489Medicare UPIN
OH310965435026Medicaid