Provider Demographics
NPI:1578741351
Name:JOHN A. RILEY, PC
Entity Type:Organization
Organization Name:JOHN A. RILEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-868-5012
Mailing Address - Street 1:PO BOX 1366
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85232-1366
Mailing Address - Country:US
Mailing Address - Phone:520-868-5012
Mailing Address - Fax:520-868-5039
Practice Address - Street 1:360 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232
Practice Address - Country:US
Practice Address - Phone:520-868-5012
Practice Address - Fax:520-868-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ79926Medicare PIN
AZU90500Medicare UPIN