Healthcare Provider Details

I. General information

NPI: 1730925769
Provider Name (Legal Business Name): CHRISTINA WENTZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E RIDGE RD
ROCHESTER NY
14621-2006
US

IV. Provider business mailing address

1455 E RIDGE RD
ROCHESTER NY
14621-2006
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-5465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberRT011046
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: