Provider Demographics
NPI:1912349770
Name:REITZ, SARAH JEAN (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:REITZ
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 1:808 N ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4912
Mailing Address - Country:US
Mailing Address - Phone:630-585-0516
Mailing Address - Fax:
Practice Address - Street 1:3500 W PETERSON AVE STE 401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3307
Practice Address - Country:US
Practice Address - Phone:773-588-3090
Practice Address - Fax:773-588-3210
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010702152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046010702Medicaid