Provider Demographics
NPI:1407816929
Name:RITZINGER OPTOMETRIC CLINIC SC
Entity Type:Organization
Organization Name:RITZINGER OPTOMETRIC CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:RITZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-425-7235
Mailing Address - Street 1:211 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016
Mailing Address - Country:US
Mailing Address - Phone:715-386-2020
Mailing Address - Fax:715-386-1600
Practice Address - Street 1:211 SECOND ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016
Practice Address - Country:US
Practice Address - Phone:715-386-2020
Practice Address - Fax:715-386-1600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RITZINGER OPTOMETRIC CLINIC SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-27
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0192060003Medicare NSC