Provider Demographics
NPI:1093709255
Name:RIEGEL, JAMES W (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:RIEGEL
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 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:235 DIVISION ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1213
Practice Address - Country:US
Practice Address - Phone:717-233-8783
Practice Address - Fax:717-233-2221
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADEG000600152W00000X
PAOEG000600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI5765OtherBLUE SHIELD
01334601OtherBLUE CROSS
RI5765OtherBLUE SHIELD
01334601OtherBLUE CROSS
901460Medicare ID - Type Unspecified