Rutheva Dizon-Moore, MD
Individual provider Active NPI Ophthalmology Physician · Riverforest, IL
NPI 1982776258 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1982776258
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Ophthalmology Physician 207W00000X
- Practice address
- 146 Park Ave
Riverforest, IL 60305 - Phone
- (708) 771-2950
- Fax
- (708) 771-2950
- NPI assigned
- Nov 14, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036053409 | IL | MD | Ophthalmology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | IL | Yes |
Addresses
Primary practice location
146 Park Ave
Riverforest, IL 60305
Mailing address
146 Park Ave
Riverforest, IL 60305
Phone (708) 771-2950
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.