Provider Demographics
NPI:1922141506
Name:RILEY VISION P.C.
Entity Type:Organization
Organization Name:RILEY VISION P.C.
Other - Org Name:W. MATTHEW RILEY
Other - Org Type:Other Name
Authorized Official - Title/Position:OD CEO
Authorized Official - Prefix:
Authorized Official - First Name:W. MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-452-2131
Mailing Address - Street 1:1867 AIRPORT WAY STE 150A
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4061
Mailing Address - Country:US
Mailing Address - Phone:907-452-2131
Mailing Address - Fax:907-452-2618
Practice Address - Street 1:1867 AIRPORT WAY STE 150A
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4061
Practice Address - Country:US
Practice Address - Phone:907-452-2131
Practice Address - Fax:907-452-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD6003Medicaid
AKU98932Medicare UPIN
AKK160777Medicare ID - Type UnspecifiedMEDICARE