Provider Demographics
NPI:1396427407
Name:RIVERSIDE EYE CENTER PA
Entity type:Organization
Organization Name:RIVERSIDE EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:207-786-1917
Mailing Address - Street 1:475 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7418
Mailing Address - Country:US
Mailing Address - Phone:207-786-2500
Mailing Address - Fax:207-786-2503
Practice Address - Street 1:475 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7418
Practice Address - Country:US
Practice Address - Phone:207-786-2500
Practice Address - Fax:207-786-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical