Provider Demographics
NPI:1740255082
Name:EHLEN, RICHARD WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WAYNE
Last Name:EHLEN
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 1:3063 VINTNER LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3848
Mailing Address - Country:US
Mailing Address - Phone:541-484-9999
Mailing Address - Fax:541-484-0616
Practice Address - Street 1:2540 WILLAKENZIE RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4805
Practice Address - Country:US
Practice Address - Phone:541-484-9999
Practice Address - Fax:541-484-0616
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2414AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU35755Medicare UPIN
ORR00WFBSKAMedicare PIN
ORROOWCJVNDMedicare PIN