Provider Demographics
NPI:1215924485
Name:GIESER, RICHARD G (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:GIESER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3152
Mailing Address - Country:US
Mailing Address - Phone:630-668-8250
Mailing Address - Fax:630-668-8916
Practice Address - Street 1:2015 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3152
Practice Address - Country:US
Practice Address - Phone:630-668-8250
Practice Address - Fax:630-668-8916
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-040663207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180012225OtherRR MEDICARE
IL036040663Medicaid
IL180012225OtherRR MEDICARE
ILP01044Medicare PIN
IL036040663Medicaid
IL0534150004Medicare NSC
IL0534150001Medicare NSC
ILC37586Medicare UPIN