Provider Demographics
NPI:1225044415
Name:DECKER-RIDDLE, CYNTHIA KAE (OD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:KAE
Last Name:DECKER-RIDDLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 STATE ROAD 167
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-9762
Mailing Address - Country:US
Mailing Address - Phone:262-670-9427
Mailing Address - Fax:
Practice Address - Street 1:203 A EAST SUNSET
Practice Address - Street 2:WISCONSIN VISION
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189
Practice Address - Country:US
Practice Address - Phone:262-670-9427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2657152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU65824Medicare UPIN