Provider Demographics
NPI:1386711794
Name:RIGGS, KEVIN MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:RIGGS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5500 GROSSMONT CENTER DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3016
Mailing Address - Country:US
Mailing Address - Phone:619-469-0131
Mailing Address - Fax:
Practice Address - Street 1:5500 GROSSMONT CENTER DR
Practice Address - Street 2:SUITE 215
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3016
Practice Address - Country:US
Practice Address - Phone:619-469-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8012T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8012TOtherSTATE LICENSE
CA8012TOtherSTATE LICENSE