Basic Information
| Provider Information | |||||||||
| NPI: | 1063856920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIRIE | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | ALEXANDER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1735 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846041010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013741818 | ||||||||
| FaxNumber: | 8013792959 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 N 1100 E | ||||||||
| Address2: | |||||||||
| City: | AMERICAN FORK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840032952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017569627 | ||||||||
| FaxNumber: | 8017630216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207W00000X | 10288924-1205 | UT | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.