Provider Demographics
NPI:1629083449
Name:UGLUM, RILEY F (OD)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:F
Last Name:UGLUM
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 470
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-0470
Mailing Address - Country:US
Mailing Address - Phone:641-394-2326
Mailing Address - Fax:641-394-2211
Practice Address - Street 1:8 E SPRING ST
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-2132
Practice Address - Country:US
Practice Address - Phone:641-394-2326
Practice Address - Fax:641-394-2211
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
18744OtherMIDLANDS CHOICE
IA0005199Medicaid
IA14577Medicare PIN
18744OtherMIDLANDS CHOICE
IA0005199Medicaid