Provider Demographics
NPI:1114111044
Name:RILEY AND RILEY
Entity Type:Organization
Organization Name:RILEY AND RILEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-341-3284
Mailing Address - Street 1:1402 N SIOUX AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3126
Mailing Address - Country:US
Mailing Address - Phone:918-341-3284
Mailing Address - Fax:918-341-3127
Practice Address - Street 1:1402 N SIOUX AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3126
Practice Address - Country:US
Practice Address - Phone:918-341-3284
Practice Address - Fax:918-341-3127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK966152W00000X
OK965152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T40622Medicare UPIN
T40621Medicare UPIN