Provider Demographics
NPI:1639656903
Name:BULLERT, RILEY (OD)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:BULLERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BRUCE RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7941
Mailing Address - Country:US
Mailing Address - Phone:530-891-1900
Mailing Address - Fax:530-895-1664
Practice Address - Street 1:1700 BRUCE RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7941
Practice Address - Country:US
Practice Address - Phone:530-891-1900
Practice Address - Fax:530-895-1664
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33995152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist