MEDICARE: RANDALL J RIEMER, OD, PLC

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	4901002984	MI

General Provider Information

NPI Number	:	1740299940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDALL J RIEMER, OD, PLC

Provider Business Mailing Address
First Line	:	207 E BRIDGE ST
Second Line	:
City	:	PORTLAND
State	:	MI
Zip	:	48875-1436
Country	:	US
Telephone Number	:	517-647-2020
Fax Number	:	517-647-7677

Provider Business Practice Location Address
First Line	:	207 E BRIDGE ST
Second Line	:
City	:	PORTLAND
State	:	MI
Zip	:	48875-1436
Country	:	US
Telephone Number	:	517-647-2020
Fax Number	:	517-647-7677

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RANDALL JOHN RIEMER
Credential	:	O.D.
Telephone Number	:	517-647-2020

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/25/2008

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