Provider Demographics
NPI:1457311219
Name:RIEDEL, WILLIAM M (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:RIEDEL
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 1:266 GROVER CLEVELAND HWY
Mailing Address - Street 2:
Mailing Address - City:EGGERTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3214
Mailing Address - Country:US
Mailing Address - Phone:716-834-7647
Mailing Address - Fax:716-834-5877
Practice Address - Street 1:266 GROVER CLEVELAND HWY
Practice Address - Street 2:
Practice Address - City:EGGERTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14226-3214
Practice Address - Country:US
Practice Address - Phone:716-834-7647
Practice Address - Fax:716-834-5877
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV00570152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01549655Medicaid
NY01549655Medicaid
NY035693Medicare ID - Type Unspecified