Provider Demographics
NPI:1912942137
Name:RILEY, RICHARD LEE (CPO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:RILEY
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:LEE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CP
Mailing Address - Street 1:220 US HIGHWAY 395 N
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89704-9582
Mailing Address - Country:US
Mailing Address - Phone:775-830-1783
Mailing Address - Fax:
Practice Address - Street 1:220 US HIGHWAY 395 N
Practice Address - Street 2:SUITE 303
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89704-9582
Practice Address - Country:US
Practice Address - Phone:775-830-1783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CP 13561744P3200X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV0362OtherBCBS
NV5895990001Medicare NSC