Provider Demographics
NPI:1114994837
Name:DEITZ, MICHAEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:DEITZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 RTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8050
Mailing Address - Country:US
Mailing Address - Phone:732-244-4400
Mailing Address - Fax:732-505-2171
Practice Address - Street 1:601 RTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8050
Practice Address - Country:US
Practice Address - Phone:732-244-4400
Practice Address - Fax:732-505-2171
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00409400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ410019838OtherRAILROAD MEDICARE
NJ2012600Medicaid
NJ136182BBUMedicare ID - Type Unspecified
NJ2012600Medicaid