Provider Demographics
NPI:1396704805
Name:RIVERHILL OPHTHALMOLOGY, P.A.
Entity type:Organization
Organization Name:RIVERHILL OPHTHALMOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ CHEDZOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-792-5059
Mailing Address - Street 1:317 SIDNEY BAKER ST S
Mailing Address - Street 2:STE 400 PMB 112
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5948
Mailing Address - Country:US
Mailing Address - Phone:830-792-5059
Mailing Address - Fax:830-792-5062
Practice Address - Street 1:601 CLAY ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4527
Practice Address - Country:US
Practice Address - Phone:830-792-5059
Practice Address - Fax:830-792-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6258207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0057NEOtherBCBS OF TEXAS
TX00W118OtherMEDICARE ID-TYPE UNSPECIF
TX00W118OtherMEDICARE ID-TYPE UNSPECIF