Provider Demographics
NPI:1679898738
Name:RITZINGER OPTOMETRIC CLINIC, S.C.
Entity Type:Organization
Organization Name:RITZINGER OPTOMETRIC CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
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:1715-425-7235
Mailing Address - Street 1:338 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-5087
Mailing Address - Country:US
Mailing Address - Phone:715-273-3570
Mailing Address - Fax:715-273-3560
Practice Address - Street 1:338 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011-5087
Practice Address - Country:US
Practice Address - Phone:715-273-3570
Practice Address - Fax:715-273-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38702000Medicaid
WI38702000Medicaid
WI0192060005Medicare NSC