Healthcare Provider Details

I. General information

NPI: 1104846336
Provider Name (Legal Business Name): THOMAS JAMES RILEY JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS JAMES KAVADIAS O.D.

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 S BERNARD ST
SPOKANE WA
99204-2509
US

IV. Provider business mailing address

427 S BERNARD ST
SPOKANE WA
99204-2509
US

V. Phone/Fax

Practice location:
  • Phone: 509-456-0107
  • Fax: 509-747-2635
Mailing address:
  • Phone: 509-456-0107
  • Fax: 509-747-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3114
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3114
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number3114
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number3114
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: