Provider Demographics
NPI:1699763458
Name:RITZEL, WILLIAM VERNON (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VERNON
Last Name:RITZEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1425
Mailing Address - Country:US
Mailing Address - Phone:618-233-1270
Mailing Address - Fax:618-233-5939
Practice Address - Street 1:22 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1425
Practice Address - Country:US
Practice Address - Phone:618-233-1270
Practice Address - Fax:618-233-5939
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-9636152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211358Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILU81959Medicare UPIN
ILK16139Medicare PIN
5426840001Medicare NSC