Provider Demographics
NPI:1427050749
Name:RICCIO, KAREN (OD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:RICCIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2683 BERWICK BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2917
Mailing Address - Country:US
Mailing Address - Phone:614-236-1401
Mailing Address - Fax:
Practice Address - Street 1:220 MARKET ST STE C
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9031
Practice Address - Country:US
Practice Address - Phone:614-855-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0800026Medicare ID - Type Unspecified