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NPI Code Detail

MEDICARE: RHONDA BRONSTON RILES O.D.

MEDICARE: RHONDA BRONSTON RILES O.D.
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
1152W00000XOptometrist3593/T1526OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952303257
Entity Type Code : Individual
Provider Name (Legal Business Name) : RHONDA BRONSTON RILES O.D.
Provider Business Mailing Address
First Line : 949 STATE ROUTE 314 SOUTH
Second Line :
City : MANSFIELD
State : OH
Zip : 44903
Country : US
Telephone Number : 419-756-7295
Fax Number : 419-756-7574
Provider Business Practice Location Address
First Line : 2485 POSSUM RUN RD
Second Line :
City : MANSFIELD
State : OH
Zip : 44903-9447
Country : US
Telephone Number : 419-756-7295
Fax Number : 419-756-7574
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 03/07/2014

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