Provider Demographics
NPI:1730315730
Name:RIOUX, NICHOLE PRESLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:PRESLEY
Last Name:RIOUX
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 1:2723 MAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1816
Mailing Address - Country:US
Mailing Address - Phone:503-952-6480
Mailing Address - Fax:
Practice Address - Street 1:5250 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1018
Practice Address - Country:US
Practice Address - Phone:503-378-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3298ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist