Provider Demographics
NPI:1952642779
Name:RIORDAN, MATTHEW J (ABO/NCLE)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:RIORDAN
Suffix:
Gender:M
Credentials:ABO/NCLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-3102
Mailing Address - Country:US
Mailing Address - Phone:716-465-6408
Mailing Address - Fax:716-836-4156
Practice Address - Street 1:49 COURT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3102
Practice Address - Country:US
Practice Address - Phone:716-465-6408
Practice Address - Fax:716-836-4156
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC-008717156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician