Provider Demographics
NPI:1376656132
Name:KRITZER, DANIEL (OPTICIAN)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KRITZER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 LEATHER STOCKING PATH
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-2338
Mailing Address - Country:US
Mailing Address - Phone:973-694-9460
Mailing Address - Fax:
Practice Address - Street 1:60 BEAVERBROOK RD
Practice Address - Street 2:SUITE 13B
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1771
Practice Address - Country:US
Practice Address - Phone:973-694-3937
Practice Address - Fax:973-694-3242
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00104502156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1001730001Medicare ID - Type Unspecified
NJ1001730001Medicare NSC