MEDICARE: KELLY REITZES O.D.

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	6492	OH

General Provider Information

NPI Number	:	1861841777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY REITZES O.D.

Provider Business Mailing Address
First Line	:	3007 LEE LN
Second Line	:
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-2619
Country	:	US
Telephone Number	:	513-675-9820
Fax Number	:	513-922-4050

Provider Business Practice Location Address
First Line	:	5303 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3706
Country	:	US
Telephone Number	:	513-922-9000
Fax Number	:	513-922-4050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	06/10/2016

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