Healthcare Provider Details

I. General information

NPI: 1093932311
Provider Name (Legal Business Name): RIOS, MASON, & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 W WICHITA AVE
COLWICH KS
67030-0036
US

IV. Provider business mailing address

PO BOX 36
COLWICH KS
67030-0036
US

V. Phone/Fax

Practice location:
  • Phone: 316-796-0002
  • Fax:
Mailing address:
  • Phone: 316-796-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1442
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. HECTOR G RIOS
Title or Position: MARORITY PARTNER
Credential: O.D.
Phone: 316-796-0002