1417981051 NPI number — DR. JAYNE LEE RIVA O.D.

Table of content: DR. JAYNE LEE RIVA O.D. (NPI 1417981051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417981051 NPI number — DR. JAYNE LEE RIVA O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVA
Provider First Name:
JAYNE
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEBER
Provider Other First Name:
JAYNE
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417981051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 CHRIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLIDAYSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16648-9654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-381-4674
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 PARK HILLS PLZ
Provider Second Line Business Practice Location Address:
WISE EYES OPTICAL
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16602-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-946-0330
Provider Business Practice Location Address Fax Number:
814-946-9381
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG001457 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)