Provider Demographics
NPI:1568478782
Name:RILEY, WILLIAM MATTHEW (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MATTHEW
Last Name:RILEY
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:PO BOX 71618
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-1618
Mailing Address - Country:US
Mailing Address - Phone:928-607-7119
Mailing Address - Fax:907-452-4829
Practice Address - Street 1:1867 AIRPORT WAY STE 150A
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4061
Practice Address - Country:US
Practice Address - Phone:907-452-4829
Practice Address - Fax:907-452-4829
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U98932Medicare UPIN