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General NPI Number Information
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NPI Number | 1073777033
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Entity Type | Individual
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Provider Name | PAMELA ANN RIEDY O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 1673 CLARKSON RD
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City | CHESTERFIELD
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State | MO
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Zip | 63017-4616
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Country | US
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Telephone | 636-368-6369
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Fax |
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Provider Business Mailing Address
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Address Line | 130 CHIPPENHAM LN
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City | CHESTERFIELD
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State | MO
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Zip | 63005-6817
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Country | US
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Telephone | 636-368-6369
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2007035140
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010176
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License Number State | IL
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