Individual provider Active NPI

Mark S Riaboy, O.D.

  • Optometrist
  • Dallas, TX
National Provider Identifier
1104815281
Registry record updated Apr 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2580TG Issued in TX
Practice address
2339 Gus Thomasson Rd
Dallas, TX 75228-3004
Phone
(214) 327-2490
Fax
(214) 324-4963
NPI assigned
Oct 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2580TG TX Primary

Addresses

Primary practice location

2339 Gus Thomasson Rd
Dallas, TX 75228-3004

Mailing address

2339 Gus Thomasson Rd
Dallas, TX 75228-3004
Phone (214) 327-2490

Other identifiers 3

IdentifierTypeStateIssuer
00E68EOtherTXTEXAS BCBS
112418202MedicaidTX
410006270OtherTXRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2580TXMDElectroneurodiagnostic Specialist/Technologist

Interoperability endpoints

  • Direct secure messaging: markriaboy@direct.eyecareteam.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239321600000",
    "number": "1104815281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2339 GUS THOMASSON RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752283004",
            "telephone_number": "214-327-2490",
            "fax_number": "214-324-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2339 GUS THOMASSON RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752283004",
            "telephone_number": "214-327-2490",
            "fax_number": "214-324-4963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIABOY",
        "first_name": "MARK",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2009-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "2580TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS BCBS",
            "identifier": "00E68E",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112418202",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410006270",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.