MEDICARE: RIKSON ZOLLINGER OD

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	709	ND
2	152W00000X	Optometrist	60575301	WA

General Provider Information

NPI Number	:	1306288105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIKSON ZOLLINGER OD

Provider Business Mailing Address
First Line	:	2615 S BOLIVAR RD
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99037-9370
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 N PINES RD STE C
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206
Country	:	US
Telephone Number	:	509-590-0607
Fax Number	:

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

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	12/07/2018

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