Provider Demographics
NPI:1104252147
Name:RIGGIO, THOMAS (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:RIGGIO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 ELLINGHOUSE DR
Mailing Address - Street 2:STE A
Mailing Address - City:COOL
Mailing Address - State:CA
Mailing Address - Zip Code:95614-9569
Mailing Address - Country:US
Mailing Address - Phone:530-333-1730
Mailing Address - Fax:530-333-1913
Practice Address - Street 1:5020 ELLINGHOUSE DR
Practice Address - Street 2:STE A
Practice Address - City:COOL
Practice Address - State:CA
Practice Address - Zip Code:95614-9569
Practice Address - Country:US
Practice Address - Phone:530-887-8048
Practice Address - Fax:877-721-2722
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6121840Medicaid
CA139325Medicare PIN