Provider Demographics
NPI:1770696494
Name:RIVERA, LUZ M (OD)
Entity type:Individual
Prefix:DR
First Name:LUZ
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:32 E GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1512
Mailing Address - Country:US
Mailing Address - Phone:610-272-1440
Mailing Address - Fax:610-272-1441
Practice Address - Street 1:32 E GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1512
Practice Address - Country:US
Practice Address - Phone:610-272-1440
Practice Address - Fax:610-272-1441
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000834152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU64615Medicare UPIN
PA574354Medicare ID - Type Unspecified