Provider Demographics
NPI:1528122967
Name:KAHN, RICHARD LELAND (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LELAND
Last Name:KAHN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2241 JAMES AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-4323
Mailing Address - Country:US
Mailing Address - Phone:530-544-9752
Mailing Address - Fax:530-544-9762
Practice Address - Street 1:2241 JAMES AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-4323
Practice Address - Country:US
Practice Address - Phone:530-544-9752
Practice Address - Fax:530-544-9762
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA5160T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4378740001Medicare UPIN