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General NPI Number Information
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NPI Number | 1164616900
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Entity Type | Individual
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Provider Name | DAVID ROGER BRITZKE O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 830 PARKWAY AVE STE E
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City | ELKHART
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State | IN
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Zip | 46516-9343
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Country | US
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Telephone | 574-970-7444
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Fax |
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Provider Business Mailing Address
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Address Line | 830 PARKWAY AVE STE E
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City | ELKHART
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State | IN
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Zip | 46516-9343
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Country | US
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Telephone | 574-970-7444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003206
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 18003206
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License Number State | IN
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