Provider Demographics
NPI:1013188564
Name:RILEY F UGLUM, OD PC
Entity Type:Organization
Organization Name:RILEY F UGLUM, OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:UGLUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-394-2326
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-0470
Mailing Address - Country:US
Mailing Address - Phone:641-394-2326
Mailing Address - Fax:641-394-2211
Practice Address - Street 1:8 E SPRING ST
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-2132
Practice Address - Country:US
Practice Address - Phone:641-394-2326
Practice Address - Fax:641-394-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1631152W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18744OtherMIDLAND'S CHOICE
P00470350OtherRAILROAD MEDICARE
IA0005199Medicaid
IAT00882Medicare UPIN
IA18744OtherMIDLAND'S CHOICE
IA0158420001Medicare NSC