Provider Demographics
NPI:1225591746
Name:RIVERVIEW OPTICAL INC.
Entity Type:Organization
Organization Name:RIVERVIEW OPTICAL INC.
Other - Org Name:WESLEY CHAPEL EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARVEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-996-2020
Mailing Address - Street 1:33913 STATE ROAD 54
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543
Mailing Address - Country:US
Mailing Address - Phone:813-996-2020
Mailing Address - Fax:813-815-9635
Practice Address - Street 1:33913 STATE ROAD 54
Practice Address - Street 2:SUITE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543
Practice Address - Country:US
Practice Address - Phone:813-996-2020
Practice Address - Fax:813-815-9635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630074000Medicaid