Individual
MR. LARRY A RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1402 N SIOUX AVE, CLAREMORE, OK 74017-3126
(918) 341-3284
(918) 341-3127
Mailing address
1402 N SIOUX AVE, CLAREMORE, OK 74017-3126
(918) 341-3284
(918) 341-3127
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
966
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100760520A
—
OK
01
—
P00442795
RAILROAD MEDICARE
OK
Enumeration date
06/09/2006
Last updated
01/26/2017
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