Healthcare Provider Details

I. General information

NPI: 1558140715
Provider Name (Legal Business Name): RIVER FICKE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIVER REMIS OD

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BEE CAVES RD
AUSTIN TX
78746-5642
US

IV. Provider business mailing address

1206 CASTLE HILL ST APT 1
AUSTIN TX
78703-4156
US

V. Phone/Fax

Practice location:
  • Phone: 512-250-2020
  • Fax: 512-250-2612
Mailing address:
  • Phone: 573-823-1806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10874
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: