Provider Demographics
NPI:1124100607
Name:PAYNE, RICHARD BARTON (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BARTON
Last Name:PAYNE
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 1:9508 SE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3633
Mailing Address - Country:US
Mailing Address - Phone:360-256-6184
Mailing Address - Fax:
Practice Address - Street 1:314 E MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3387
Practice Address - Country:US
Practice Address - Phone:360-694-8303
Practice Address - Fax:360-694-9032
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000943152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA024356001OtherREGENCE
WA212767OtherEYE MED
WA0199300OtherDEPT. OF LABOR AND INDUST
WA410008557OtherRR MEDICARE
WA2004273Medicaid
WA0199300OtherDEPT. OF LABOR AND INDUST
WA000685204Medicare ID - Type Unspecified