Provider Demographics
NPI:1679686612
Name:RIBACK, ARNOLD (OD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:
Last Name:RIBACK
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 1:848 NAZARETH PK
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064
Mailing Address - Country:US
Mailing Address - Phone:610-746-0992
Mailing Address - Fax:610-365-8468
Practice Address - Street 1:848 NAZARETH PK
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064
Practice Address - Country:US
Practice Address - Phone:610-746-0992
Practice Address - Fax:610-365-8468
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG001005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T28118Medicare UPIN
PARI67950Medicare ID - Type Unspecified