Provider Demographics
NPI:1679271993
Name:RILEY, CHELSI (OPT)
Entity Type:Individual
Prefix:
First Name:CHELSI
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:OPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 MAYSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-8967
Mailing Address - Country:US
Mailing Address - Phone:740-452-5047
Mailing Address - Fax:740-452-5275
Practice Address - Street 1:2850 MAYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-8800
Practice Address - Country:US
Practice Address - Phone:740-452-5047
Practice Address - Fax:740-452-5275
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician