MEDICARE: DR. SUZANNE ELAINE RIFFEL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	450	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	450	OTHER	NV	NEVADA STATE BOARD OF OPTOMETRY

General Provider Information

NPI Number	:	1073812061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE ELAINE RIFFEL O.D.

Provider Business Mailing Address
First Line	:	1975 ALCOVA RIDGE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1551
Country	:	US
Telephone Number	:	702-341-0255
Fax Number	:

Provider Business Practice Location Address
First Line	:	2075 FESTIVAL PLAZA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1446
Country	:	US
Telephone Number	:	702-341-0255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	04/20/2019

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