Provider Demographics
NPI:1588615132
Name:FLAITZ, LORETTA M (OD, MBA)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:M
Last Name:FLAITZ
Suffix:
Gender:F
Credentials:OD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 YALE CT
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9326
Mailing Address - Country:US
Mailing Address - Phone:605-200-0930
Mailing Address - Fax:
Practice Address - Street 1:2926 YALE CT
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-9326
Practice Address - Country:US
Practice Address - Phone:605-200-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK236152W00000X
SD660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist