Provider Demographics
NPI:1932211422
Name:RUE, RICHARD ORLANDO (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ORLANDO
Last Name:RUE
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 1:20225 97TH CT S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-1473
Mailing Address - Country:US
Mailing Address - Phone:253-856-7573
Mailing Address - Fax:253-826-9158
Practice Address - Street 1:19205 STATE ROUTE 410 E
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-6305
Practice Address - Country:US
Practice Address - Phone:253-826-9156
Practice Address - Fax:253-826-9158
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1985152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5364RUOtherBLUE SHIELD
WARU6632OtherBLUE SHIELD
WA5364RUOtherBLUE SHIELD
WARU6632OtherBLUE SHIELD
WA43266Medicare UPIN