Provider Demographics
NPI:1952346967
Name:RIVERA, REUBEN KAMIYA (OD MS FAAO)
Entity Type:Individual
Prefix:DR
First Name:REUBEN
Middle Name:KAMIYA
Last Name:RIVERA
Suffix:
Gender:M
Credentials:OD MS FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1603
Mailing Address - Country:US
Mailing Address - Phone:510-653-4242
Mailing Address - Fax:510-653-4275
Practice Address - Street 1:5802 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1603
Practice Address - Country:US
Practice Address - Phone:510-653-4242
Practice Address - Fax:510-653-4275
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8313T152W00000X, 152WC0802X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHM465ZMedicare PIN
CADO017AMedicare PIN