Provider Demographics
NPI:1609089358
Name:RIVENSON, CYNTHIA LO (OD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LO
Last Name:RIVENSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:M
Other - Last Name:LO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:8022 TANGELO DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436
Mailing Address - Country:US
Mailing Address - Phone:561-374-3496
Mailing Address - Fax:
Practice Address - Street 1:5555 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5296
Practice Address - Country:US
Practice Address - Phone:954-977-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist