Healthcare Provider Details

I. General information

NPI: 1013994151
Provider Name (Legal Business Name): RIVERBEND OPHTHALMOLOGISTS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 DADRIAN PROFESSIONAL PARK
GODFREY IL
62035-1685
US

IV. Provider business mailing address

1310 DADRIAN PROFESSIONAL PARK
GODFREY IL
62035-1685
US

V. Phone/Fax

Practice location:
  • Phone: 618-433-5005
  • Fax: 618-467-1053
Mailing address:
  • Phone: 618-433-5005
  • Fax: 618-467-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES MELVIN HUDSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 618-433-5005