Provider Demographics
NPI:1467598433
Name:REITZFELD, JOAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:REITZFELD
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 1:1 LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:TUXEDO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:10987-4033
Mailing Address - Country:US
Mailing Address - Phone:845-351-5744
Mailing Address - Fax:845-351-5356
Practice Address - Street 1:10 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2304
Practice Address - Country:US
Practice Address - Phone:845-351-5744
Practice Address - Fax:845-351-5356
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT003576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC29661Medicare PIN