Provider Demographics
NPI:1801096532
Name:RILEY, CARRIE C (OD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:C
Last Name:RILEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:C
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:16882 BABLER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011
Mailing Address - Country:US
Mailing Address - Phone:314-486-3209
Mailing Address - Fax:
Practice Address - Street 1:1235 WATER TOWER PLACE
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010
Practice Address - Country:US
Practice Address - Phone:636-296-8612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007018534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist