Provider Demographics
NPI:1003865833
Name:RIVERCITY EYECARE, INC
Entity Type:Organization
Organization Name:RIVERCITY EYECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-423-9521
Mailing Address - Street 1:1714 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-2096
Mailing Address - Country:US
Mailing Address - Phone:740-423-9521
Mailing Address - Fax:
Practice Address - Street 1:1714 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-2096
Practice Address - Country:US
Practice Address - Phone:740-423-9521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5250508Medicaid
OHRI93550881Medicare PIN
OHY27295Medicare UPIN
OH5250508Medicaid