Provider Demographics
NPI:1922088335
Name:RIOUX, TIMOTHY DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DAVID
Last Name:RIOUX
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 1:29 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1203
Mailing Address - Country:US
Mailing Address - Phone:207-834-3333
Mailing Address - Fax:207-834-6095
Practice Address - Street 1:29 MEADOW LN
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1203
Practice Address - Country:US
Practice Address - Phone:207-834-3333
Practice Address - Fax:207-834-6095
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT773TA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME128740000Medicaid
017032OtherANTHEM
2023142OtherAETNA
MM4230OtherRAILROAD MEDICARE
U31269Medicare UPIN
ME1020820001Medicare NSC