Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3114 | WA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3114 | WA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 3114 | WA |
N | 152WX0102X | Occupational Vision | 3114 | WA |
NPI | 1104846336 |
---|---|
Provider Name | Dr. Thomas James Riley JR. |
First Address | Spokane, WA 99204-2509 |
Second Address | Spokane, WA 99204-2509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 16/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2032795 | (05) | WA |