Provider Demographics
NPI:1891486932
Name:PEDEN, RICHARD BRUCE
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRUCE
Last Name:PEDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7984
Mailing Address - Country:US
Mailing Address - Phone:775-883-6578
Mailing Address - Fax:775-883-6586
Practice Address - Street 1:3200 MARKET ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7984
Practice Address - Country:US
Practice Address - Phone:775-883-6578
Practice Address - Fax:775-883-6586
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician