Provider Demographics
NPI:1366548828
Name:DEAN, RICHARD E (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:DEAN
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 1:103 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TONGANOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:66086-9770
Mailing Address - Country:US
Mailing Address - Phone:913-845-2030
Mailing Address - Fax:913-845-9444
Practice Address - Street 1:103 W 4TH ST
Practice Address - Street 2:
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-9770
Practice Address - Country:US
Practice Address - Phone:913-845-2030
Practice Address - Fax:913-845-9444
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS992-6152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100090660AMedicaid
KS0341760001Medicare NSC
KS100090660AMedicaid
KST42373Medicare UPIN