Provider Demographics
NPI:1619711785
Name:MCEVOY, RICHARD RYAN (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RYAN
Last Name:MCEVOY
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 1:1150 NW QUIMBY ST UNIT 228
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2488
Mailing Address - Country:US
Mailing Address - Phone:503-707-1472
Mailing Address - Fax:
Practice Address - Street 1:36840 INDUSTRIAL WAY STE D
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-9254
Practice Address - Country:US
Practice Address - Phone:503-482-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI4743152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty