Provider Demographics
NPI:1417981051
Name:RIVA, JAYNE LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAYNE
Middle Name:LEE
Last Name:RIVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JAYNE
Other - Middle Name:LEE
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:216 CHRIS ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-9654
Mailing Address - Country:US
Mailing Address - Phone:814-381-4674
Mailing Address - Fax:
Practice Address - Street 1:249 PARK HILLS PLZ
Practice Address - Street 2:WISE EYES OPTICAL
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2829
Practice Address - Country:US
Practice Address - Phone:814-946-0330
Practice Address - Fax:814-946-9381
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA086315THXMedicare PIN
PAV02650Medicare UPIN