=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679898738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITZINGER OPTOMETRIC CLINIC, S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2010
-----------------------------------------------------
Last Update Date | 12/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 338 W MAIN ST
-----------------------------------------------------
City | ELLSWORTH
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54011-5087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-273-3570
-----------------------------------------------------
Fax | 715-273-3560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 338 W MAIN ST
-----------------------------------------------------
City | ELLSWORTH
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54011-5087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-273-3570
-----------------------------------------------------
Fax | 715-273-3560
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | MR. MARK L RITZINGER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 17154257235
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------