Provider Demographics
NPI:1629261854
Name:RIVIERA OPTICARE INC.
Entity Type:Organization
Organization Name:RIVIERA OPTICARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RECKELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-827-9184
Mailing Address - Street 1:8752 E SHEA BLVD
Mailing Address - Street 2:SUITE C10
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6640
Mailing Address - Country:US
Mailing Address - Phone:480-991-6432
Mailing Address - Fax:
Practice Address - Street 1:8752 E SHEA BLVD
Practice Address - Street 2:SUITE C10
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6640
Practice Address - Country:US
Practice Address - Phone:480-991-6432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ63804Medicare PIN