Provider Demographics
NPI:1659894822
Name:CECILIA A RIVAS OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CECILIA A RIVAS OD A PROFESSIONAL CORPORATION
Other - Org Name:RIVAS OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:ALEJANDRA
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-860-4094
Mailing Address - Street 1:PO BOX 1051
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-0051
Mailing Address - Country:US
Mailing Address - Phone:562-201-7740
Mailing Address - Fax:
Practice Address - Street 1:11729 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2819
Practice Address - Country:US
Practice Address - Phone:562-860-4094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty