Provider Demographics
NPI:1851469878
Name:KLAEHN, RICHARD J (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:KLAEHN
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 1:4536 MAPLECREST ROAD
Mailing Address - Street 2:
Mailing Address - City:FT. WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835
Mailing Address - Country:US
Mailing Address - Phone:260-485-6406
Mailing Address - Fax:
Practice Address - Street 1:4536 MAPLECREST ROAD
Practice Address - Street 2:
Practice Address - City:FT. WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835
Practice Address - Country:US
Practice Address - Phone:260-485-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001690A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist