Provider Demographics
NPI:1144391624
Name:REITER, JOLENE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:ANN
Last Name:REITER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SARATOGA BLVD E
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8281
Mailing Address - Country:US
Mailing Address - Phone:561-798-7432
Mailing Address - Fax:
Practice Address - Street 1:137 SOUTH STATE ROAD 7
Practice Address - Street 2:SUITE 303
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-798-7432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002912152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
72305Medicare UPIN