Provider Demographics
NPI:1831204411
Name:SPADY, RICHARD ALAN (RIC SPADY)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALAN
Last Name:SPADY
Suffix:
Gender:M
Credentials:RIC SPADY
Other - Prefix:
Other - First Name:RIC
Other - Middle Name:A
Other - Last Name:SPADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RIC SPADY
Mailing Address - Street 1:6844 N WALL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-5632
Mailing Address - Country:US
Mailing Address - Phone:503-286-0182
Mailing Address - Fax:
Practice Address - Street 1:10200 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8969
Practice Address - Country:US
Practice Address - Phone:503-571-5659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician