Provider Demographics
NPI:1710328976
Name:RIVERA, GIEZEL (OD)
Entity Type:Individual
Prefix:
First Name:GIEZEL
Middle Name:
Last Name:RIVERA
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 1:101 AUPUNI ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4246
Mailing Address - Country:US
Mailing Address - Phone:808-935-6319
Mailing Address - Fax:808-961-0198
Practice Address - Street 1:101 AUPUNI ST
Practice Address - Street 2:SUITE 305
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4246
Practice Address - Country:US
Practice Address - Phone:808-935-6319
Practice Address - Fax:808-961-0198
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002834152W00000X
HIOD795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12564339OtherCAQH PROVIDER NUMBER
PA298062Medicare PIN