Provider Demographics
NPI:1033185061
Name:RISHKO, J. RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:RICHARD
Last Name:RISHKO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 OWENSMOUTH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-3159
Mailing Address - Country:US
Mailing Address - Phone:818-340-5796
Mailing Address - Fax:818-340-4030
Practice Address - Street 1:6800 OWENSMOUTH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-3159
Practice Address - Country:US
Practice Address - Phone:818-340-5796
Practice Address - Fax:818-340-4030
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7040 TPL152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0070400Medicaid
CAU28051Medicare UPIN
CAWOP7040AMedicare ID - Type Unspecified
CASD0070400Medicaid