Provider Demographics
NPI:1063561066
Name:RITZER, RENEE M (OD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:RITZER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13195 WEAVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-9410
Mailing Address - Country:US
Mailing Address - Phone:763-420-5112
Mailing Address - Fax:763-420-6957
Practice Address - Street 1:13195 WEAVER LAKE ROAD
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-599-0153
Practice Address - Fax:763-420-6957
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2414152W00000X
WI2614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU47843OtherWOODBURY