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General NPI Number Information
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NPI Number | 1578741351
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Entity Type | Organization
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Legal Business Name | JOHN A. RILEY, PC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 360 N. MAIN STREET
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City | FLORENCE
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State | AZ
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Zip | 85232
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Country | US
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Telephone | 520-868-5012
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Fax | 520-868-5039
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Provider Business Mailing Address
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Address Line | PO BOX 1366
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City | FLORENCE
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State | AZ
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Zip | 85232-1366
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Country | US
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Telephone | 520-868-5012
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Fax | 520-868-5039
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN RILEY
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Credential | O.D.
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Telephone | 520-868-5012
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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 | 1207
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License Number State | AZ
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