Healthcare Provider Details

I. General information

NPI: 1033185061
Provider Name (Legal Business Name): J. RICHARD RISHKO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 OWENSMOUTH AVE SUITE 400
CANOGA PARK CA
91303-3159
US

IV. Provider business mailing address

6800 OWENSMOUTH AVE SUITE 400
CANOGA PARK CA
91303-3159
US

V. Phone/Fax

Practice location:
  • Phone: 818-340-5796
  • Fax: 818-340-4030
Mailing address:
  • Phone: 818-340-5796
  • Fax: 818-340-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number7040 TPL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: