Provider Demographics
NPI:1124354998
Name:DO, RICHARD (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:DO
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 1:5631 S 150TH ST
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-7782
Mailing Address - Country:US
Mailing Address - Phone:206-383-4939
Mailing Address - Fax:
Practice Address - Street 1:16502 MERIDIAN E
Practice Address - Street 2:NEXT TO WALMART VISION CENTER
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-2515
Practice Address - Country:US
Practice Address - Phone:253-446-1760
Practice Address - Fax:253-446-1762
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD.60113728152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist