Provider Demographics
NPI:1972554988
Name:RIEGER, THOMAS J
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:RIEGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 E ARROWHEAD PKWY
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-2701
Mailing Address - Country:US
Mailing Address - Phone:605-335-8831
Mailing Address - Fax:
Practice Address - Street 1:4501 E ARROWHEAD PKWY
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-2701
Practice Address - Country:US
Practice Address - Phone:605-335-8831
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201750Medicaid
SDU94432Medicare UPIN
SD9201750Medicaid