Provider Demographics
NPI:1457406662
Name:RISNER, ASHLEY HALBERT (OD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:HALBERT
Last Name:RISNER
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 1:4078 CROOKED CREEK PATH
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-2069
Mailing Address - Country:US
Mailing Address - Phone:979-587-4848
Mailing Address - Fax:
Practice Address - Street 1:2806 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2601
Practice Address - Country:US
Practice Address - Phone:979-776-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06101TG152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148211902Medicaid
TX80714QOtherBCBS
TX80714QOtherBCBS
TXU87543Medicare UPIN