MEDICARE: MR. RONALD ARTHUR RIESZ RDO

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	156FX1800X	Optician	1304	MA

General Provider Information

NPI Number	:	1205953304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD ARTHUR RIESZ RDO

Provider Business Mailing Address
First Line	:	452 MASSACHUSETTS AVE
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-5106
Country	:	US
Telephone Number	:	781-643-7325
Fax Number	:	781-643-1326

Provider Business Practice Location Address
First Line	:	452 MASSACHUSETTS AVE
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-5106
Country	:	US
Telephone Number	:	781-643-7325
Fax Number	:	781-643-1326

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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