MEDICARE: DR. MARK S RIABOY 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	2580TG	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	410006270	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00E68E	OTHER	TX	TEXAS BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104815281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK S RIABOY O.D.

Provider Business Mailing Address
First Line	:	2339 GUS THOMASSON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-3004
Country	:	US
Telephone Number	:	214-327-2490
Fax Number	:	214-324-4963

Provider Business Practice Location Address
First Line	:	2339 GUS THOMASSON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-3004
Country	:	US
Telephone Number	:	214-327-2490
Fax Number	:	214-324-4963

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	04/10/2009

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