Provider Demographics
NPI:1750461216
Name:RICCIARDONE, LOUIS FRANCIS JR (OD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:FRANCIS
Last Name:RICCIARDONE
Suffix:JR
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 1:126 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530
Mailing Address - Country:US
Mailing Address - Phone:207-443-5012
Mailing Address - Fax:
Practice Address - Street 1:126 FRONT STREET
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530
Practice Address - Country:US
Practice Address - Phone:207-443-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME 571TA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0384770001OtherDME SUPPLY NUMBER
ME0384770001OtherDME SUPPLY NUMBER
ME701121Medicare ID - Type Unspecified