Provider Demographics
NPI:1447235007
Name:DEGEN, RICHARD LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LOUIS
Last Name:DEGEN
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:PO BOX 61896
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-1896
Mailing Address - Country:US
Mailing Address - Phone:360-823-2012
Mailing Address - Fax:360-823-2260
Practice Address - Street 1:3200 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2753
Practice Address - Country:US
Practice Address - Phone:360-696-4691
Practice Address - Fax:360-823-2260
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2018810Medicaid
WA2018810Medicaid
AB00417Medicare PIN
WA2018810Medicaid
U35514Medicare UPIN