Provider Demographics
NPI:1205828514
Name:RIEGER, JAMES C (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:RIEGER
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 1:1463 WESTBROOKE MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7534
Mailing Address - Country:US
Mailing Address - Phone:636-225-2236
Mailing Address - Fax:
Practice Address - Street 1:1815 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5065
Practice Address - Country:US
Practice Address - Phone:636-728-0111
Practice Address - Fax:636-728-0093
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU02585Medicare UPIN