Provider Demographics
NPI:1669675195
Name:RIVERVIEW OPTICAL, INC
Entity Type:Organization
Organization Name:RIVERVIEW OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-255-8200
Mailing Address - Street 1:330 1ST CAPITOL DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2835
Mailing Address - Country:US
Mailing Address - Phone:636-255-8200
Mailing Address - Fax:636-947-9425
Practice Address - Street 1:330 1ST CAPITOL DRIVE
Practice Address - Street 2:SUITE 330
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2835
Practice Address - Country:US
Practice Address - Phone:636-255-8200
Practice Address - Fax:636-947-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO17926211332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4371260001Medicare NSC