Provider Demographics
NPI:1801994215
Name:LETHERER, RICHARD ROY (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROY
Last Name:LETHERER
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 1:14 SW NYE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3821
Mailing Address - Country:US
Mailing Address - Phone:541-265-8828
Mailing Address - Fax:541-265-8829
Practice Address - Street 1:14 SW NYE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3821
Practice Address - Country:US
Practice Address - Phone:541-265-8828
Practice Address - Fax:541-265-8829
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1707ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR086645Medicaid
005286001OtherREGENCE BCBSO
T67845Medicare UPIN
OR0000PHFQXMedicare ID - Type Unspecified
005286001OtherREGENCE BCBSO