Provider Demographics
NPI:1588993422
Name:CORNERSTONE OPTOMETRY PLLC
Entity type:Organization
Organization Name:CORNERSTONE OPTOMETRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RIKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-733-5530
Mailing Address - Street 1:2221 BLISSFIELD CT
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4413
Mailing Address - Country:US
Mailing Address - Phone:231-733-5530
Mailing Address - Fax:231-733-5585
Practice Address - Street 1:3285 HENRY ST
Practice Address - Street 2:TODD J. RIKER, O.D. / VISION CENTER
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4019
Practice Address - Country:US
Practice Address - Phone:231-739-4728
Practice Address - Fax:231-739-4730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004230152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty