Provider Demographics
NPI:1194805481
Name:RIOS, RIC R (OD)
Entity type:Individual
Prefix:DR
First Name:RIC
Middle Name:R
Last Name:RIOS
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 1:12450 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7160
Mailing Address - Country:US
Mailing Address - Phone:602-494-0054
Mailing Address - Fax:602-788-8431
Practice Address - Street 1:12450 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7160
Practice Address - Country:US
Practice Address - Phone:602-494-0054
Practice Address - Fax:602-788-8431
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ536152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4835450001Medicaid
AZZ64431Medicare PIN
AZ4835450001Medicaid