MEDICARE: DR. GREGORY CLELL RIFFLE MD

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	207W00000X	Ophthalmology Physician	35-04-2489-R	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	180010464	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000126784	OTHER	OH	ANTHEM
2	1240023	OTHER	OH	UNITED HEALTH CARE
3	104703	OTHER		KAISER
5	34158	OTHER	OH	HEALTH DESIGN

General Provider Information

NPI Number	:	1669474938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY CLELL RIFFLE MD

Provider Business Mailing Address
First Line	:	8140 NORTON PKWY STE 110
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-6017
Country	:	US
Telephone Number	:	440-255-1115
Fax Number	:	440-255-1550

Provider Business Practice Location Address
First Line	:	8140 NORTON PKWY STE 110
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-6017
Country	:	US
Telephone Number	:	440-255-1115
Fax Number	:	440-255-1550

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/19/2024

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Directions to “ DR. GREGORY CLELL RIFFLE MD” Practice Location

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