Healthcare Provider Details

I. General information

NPI: 1144391624
Provider Name (Legal Business Name): JOLENE ANN REITER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 SOUTH STATE ROAD 7 SUITE 303
ROYAL PALM BEACH FL
33414
US

IV. Provider business mailing address

216 SARATOGA BLVD E
ROYAL PALM BEACH FL
33411-8281
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-7432
  • Fax:
Mailing address:
  • Phone: 561-798-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC002912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: