Provider Demographics
NPI:1629485735
Name:RIX, GEORGE R (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:RIX
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 1:8 DUNLAP CT
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9501
Mailing Address - Country:US
Mailing Address - Phone:815-343-7542
Mailing Address - Fax:217-239-0093
Practice Address - Street 1:8 DUNLAP CT
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9501
Practice Address - Country:US
Practice Address - Phone:815-343-7542
Practice Address - Fax:217-239-0093
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046.010788OtherSTATE LICENSCE