Provider Demographics
NPI:1255851887
Name:THERESA RADTKE, OD LLC
Entity Type:Organization
Organization Name:THERESA RADTKE, OD LLC
Other - Org Name:INSIGHT EYE AND VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADTKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-913-7808
Mailing Address - Street 1:1053 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-2120
Mailing Address - Country:US
Mailing Address - Phone:973-594-0020
Mailing Address - Fax:973-594-0120
Practice Address - Street 1:1053 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2120
Practice Address - Country:US
Practice Address - Phone:973-594-0020
Practice Address - Fax:973-594-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-24
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00667600152W00000X
NYTUV008483152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty