Provider Demographics
NPI:1942420708
Name:RIGG, MAHLON LAYTON (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:MAHLON
Middle Name:LAYTON
Last Name:RIGG
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:RIGG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:322 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-1918
Mailing Address - Country:US
Mailing Address - Phone:361-758-4301
Mailing Address - Fax:361-758-4076
Practice Address - Street 1:322 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-1918
Practice Address - Country:US
Practice Address - Phone:361-758-4301
Practice Address - Fax:361-758-4076
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1186780001Medicare PIN