Basic Information
| Provider Information | |||||||||
| NPI: | 1568529105 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COREY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 N 300 W | ||||||||
| Address2: | STE 210 | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013577704 | ||||||||
| FaxNumber: | 8013577424 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 N 300 W | ||||||||
| Address2: | STE 210 | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013577704 | ||||||||
| FaxNumber: | 8013577424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 52668101205 | UT | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | MD00043978 | WA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0107X | 52668101205 | UT | Y |
ID Information
| ID | Type | State | Issuer | Description | 4539CO | 01 | WA | REGENCE INSURANCE NUM | OTHER | 4532CO | 01 | WA | REGENCE INSURANCE NUM | OTHER | 5393CO | 01 | WA | REGENCE INSURANCE NUM | OTHER | 8398349 | 05 | WA | MEDICAID | 3933CO | 01 | WA | REGENCE INSURANCE NUM | OTHER | 0186949 | 01 | WA | DEPT OF LABOR AND INDUSTR | OTHER |