MEDICARE: RIC RIOS OD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	536	AZ

General Provider Information

NPI Number	:	1083794465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIC RIOS OD PC

Provider Business Mailing Address
First Line	:	12450 N 32ND ST STE 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7160
Country	:	US
Telephone Number	:	602-494-0054
Fax Number	:	602-788-8431

Provider Business Practice Location Address
First Line	:	12450 N 32ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7160
Country	:	US
Telephone Number	:	602-494-0054
Fax Number	:	602-788-8431

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. RIC R RIOS
Credential	:
Telephone Number	:	602-494-0054

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/19/2026

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