Provider Demographics
NPI:1386086064
Name:RISKO, ADAM R (OD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:R
Last Name:RISKO
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 1:4425 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2648
Mailing Address - Country:US
Mailing Address - Phone:269-345-4425
Mailing Address - Fax:269-345-4435
Practice Address - Street 1:4425 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2648
Practice Address - Country:US
Practice Address - Phone:269-345-4425
Practice Address - Fax:269-345-4435
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004810152W00000X
CO3010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist