Provider Demographics
NPI:1255990958
Name:SUTHERLIN, RILEY ANN (OD)
Entity type:Individual
Prefix:DR
First Name:RILEY
Middle Name:ANN
Last Name:SUTHERLIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-4476
Mailing Address - Country:US
Mailing Address - Phone:317-926-0283
Mailing Address - Fax:
Practice Address - Street 1:2475 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-4476
Practice Address - Country:US
Practice Address - Phone:317-926-0283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004160B152W00000X
IN18004160A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist