Provider Demographics
NPI:1598763716
Name:FARKHONDEPAY-ARYAH, KEYHAN (MD)
Entity Type:Individual
Prefix:
First Name:KEYHAN
Middle Name:
Last Name:FARKHONDEPAY-ARYAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 OAK ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7701
Mailing Address - Country:US
Mailing Address - Phone:541-687-1927
Mailing Address - Fax:541-683-8779
Practice Address - Street 1:1550 OAK ST
Practice Address - Street 2:SUITE 7
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7701
Practice Address - Country:US
Practice Address - Phone:541-687-1927
Practice Address - Fax:541-683-8779
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17703207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR041389Medicaid
180018630OtherRAILROAD MEDICARE
180039026OtherMEDICARE, RR
180039025OtherMEDICARE RR
OR041389Medicaid
R018WCHTCFMedicare PIN
180039025OtherMEDICARE RR