Provider Demographics
NPI:1871570028
Name:KELLOGG, RICHARD E (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:KELLOGG
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 1:126 N WASHINGTON
Mailing Address - Street 2:EYE CARE TEAM
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0252
Mailing Address - Country:US
Mailing Address - Phone:509-747-6581
Mailing Address - Fax:509-747-6354
Practice Address - Street 1:126 N WASHINGTON
Practice Address - Street 2:EYE CARE TEAM
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0252
Practice Address - Country:US
Practice Address - Phone:509-747-6581
Practice Address - Fax:509-747-6354
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001192152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035202Medicaid
WAOD00001192OtherOD LICENSE
WAOD00001192OtherOD LICENSE
MK1172307OtherDEA US DEPT OF JUSTICE
WA2035202Medicaid