Provider Demographics
NPI:1649023144
Name:DR. ADAM R. RISKO, OD PLLC
Entity type:Organization
Organization Name:DR. ADAM R. RISKO, OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-345-4425
Mailing Address - Street 1:4425 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2648
Mailing Address - Country:US
Mailing Address - Phone:269-345-4425
Mailing Address - Fax:269-345-4435
Practice Address - Street 1:4425 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2648
Practice Address - Country:US
Practice Address - Phone:269-345-4425
Practice Address - Fax:269-345-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty