Healthcare Provider Details

I. General information

NPI: 1376533703
Provider Name (Legal Business Name): RICHARD S. DOHODA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 TALBOT RD S STE 100
RENTON WA
98055-5738
US

IV. Provider business mailing address

PO BOX 34876
RENTON WA
98055
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-5345
  • Fax: 425-656-5349
Mailing address:
  • Phone: 425-228-3440
  • Fax: 425-656-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00046073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: