Provider Demographics
NPI:1558322727
Name:RIGGS, KIMBERLY RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RENEE
Last Name:RIGGS
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 1:283 ROSS MOUNTAIN PARK RD
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-2628
Mailing Address - Country:US
Mailing Address - Phone:724-238-8694
Mailing Address - Fax:
Practice Address - Street 1:283 ROSS MOUNTAIN PARK RD
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-2628
Practice Address - Country:US
Practice Address - Phone:724-238-8694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000645152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU21390Medicare UPIN
PARI685172Medicare ID - Type Unspecified