Provider Demographics
NPI:1407827090
Name:STRAIN, RICHARD ERIC (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ERIC
Last Name:STRAIN
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 1:600 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3210
Mailing Address - Country:US
Mailing Address - Phone:989-684-8840
Mailing Address - Fax:989-684-2536
Practice Address - Street 1:600 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3210
Practice Address - Country:US
Practice Address - Phone:989-684-8840
Practice Address - Fax:989-684-2536
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI945097861Medicaid
MI0005497677OtherAETNA PIN NUMBER
MI900Z965190OtherBLUE CROSS ID NUMBER
MI900Z965190OtherBLUE CROSS ID NUMBER
MI945097861Medicaid