Provider Demographics
NPI:1114003969
Name:RIOS, HECTOR G (OD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:G
Last Name:RIOS
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 1:3040 S SENECA ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-3246
Mailing Address - Country:US
Mailing Address - Phone:316-522-6311
Mailing Address - Fax:
Practice Address - Street 1:3040 S SENECA ST STE 2
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-3246
Practice Address - Country:US
Practice Address - Phone:316-522-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS651104OtherBCBS
KS100220070Medicaid
KS651104OtherBCBS
KS650959Medicare ID - Type UnspecifiedMEDICARE