Provider Demographics
NPI:1558140715
Name:FICKE, RIVER (OD)
Entity type:Individual
Prefix:DR
First Name:RIVER
Middle Name:
Last Name:FICKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RIVER
Other - Middle Name:
Other - Last Name:REMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1206 CASTLE HILL ST APT 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4156
Mailing Address - Country:US
Mailing Address - Phone:573-823-1806
Mailing Address - Fax:
Practice Address - Street 1:2700 BEE CAVES RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5642
Practice Address - Country:US
Practice Address - Phone:512-250-2020
Practice Address - Fax:512-250-2612
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist