Provider Demographics
NPI:1306064324
Name:RILEY, BRANDT MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:BRANDT
Middle Name:MICHAEL
Last Name:RILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1877
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-1877
Mailing Address - Country:US
Mailing Address - Phone:641-423-8861
Mailing Address - Fax:641-423-0727
Practice Address - Street 1:HWY 122
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50402-1877
Practice Address - Country:US
Practice Address - Phone:641-423-8861
Practice Address - Fax:641-423-0727
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-8629207W00000X
IA3892207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology