MEDICARE: RITZINGER OPTOMETRIC CLINIC, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679898738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITZINGER OPTOMETRIC CLINIC, S.C.

Provider Business Mailing Address
First Line	:	338 W MAIN ST
Second Line	:
City	:	ELLSWORTH
State	:	WI
Zip	:	54011-5087
Country	:	US
Telephone Number	:	715-273-3570
Fax Number	:	715-273-3560

Provider Business Practice Location Address
First Line	:	338 W MAIN ST
Second Line	:
City	:	ELLSWORTH
State	:	WI
Zip	:	54011-5087
Country	:	US
Telephone Number	:	715-273-3570
Fax Number	:	715-273-3560

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	MR. MARK L RITZINGER
Credential	:	O.D.
Telephone Number	:	17154257235

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	12/09/2010

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