MEDICARE: RILEY F UGLUM OD

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	1631	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18744	OTHER		MIDLANDS CHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629083449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY F UGLUM OD

Provider Business Mailing Address
First Line	:	PO BOX 470
Second Line	:
City	:	NEW HAMPTON
State	:	IA
Zip	:	50659-0470
Country	:	US
Telephone Number	:	641-394-2326
Fax Number	:	641-394-2211

Provider Business Practice Location Address
First Line	:	8 E SPRING ST
Second Line	:
City	:	NEW HAMPTON
State	:	IA
Zip	:	50659-2132
Country	:	US
Telephone Number	:	641-394-2326
Fax Number	:	641-394-2211

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	05/17/2022

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