Individual
DR. MARY T RIEGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2 ASPEN CT, FAIRBURY, IL 61739-1487
(815) 692-2415
(815) 692-2675
Mailing address
2 ASPEN CT, FAIRBURY, IL 61739-1487
(815) 692-2415
(815) 692-2675
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-008997
IL
152WC0802X
Corneal and Contact Management Optometrist
046-008997
IL
152WV0400X
Vision Therapy Optometrist
046-008997
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008997
—
IL
01
—
05732151
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/13/2005
Last updated
07/23/2020
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