Provider Demographics
NPI:1205892825
Name:RIEDEL, JOHN FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FREDERICK
Last Name:RIEDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:112 LA CASA VIA
Mailing Address - Street 2:#260
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-934-6300
Mailing Address - Fax:925-933-9547
Practice Address - Street 1:112 LA CASA VIA
Practice Address - Street 2:#260
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-934-6300
Practice Address - Fax:925-933-9547
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A239850207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A239850Medicare ID - Type Unspecified
A23780Medicare UPIN