Provider Demographics
NPI:1649268673
Name:RITZINGER, MARK L (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:RITZINGER
Suffix:
Gender:M
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:PO BOX 209
Mailing Address - Street 2:711 N MAIN ST
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-0209
Mailing Address - Country:US
Mailing Address - Phone:715-425-7235
Mailing Address - Fax:715-425-2140
Practice Address - Street 1:711 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-3502
Practice Address - Country:US
Practice Address - Phone:715-425-7235
Practice Address - Fax:715-425-2140
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1550 035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38562400Medicaid
MR0094918OtherDEA
T63112Medicare UPIN
MR0094918OtherDEA