Provider Demographics
NPI:1538355839
Name:REITER, CAROLINE (OD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:REITER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:MACHNICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:910 MAIN RD
Mailing Address - Street 2:BOX 22
Mailing Address - City:WASHINGTON ISLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54246-9004
Mailing Address - Country:US
Mailing Address - Phone:920-847-3093
Mailing Address - Fax:
Practice Address - Street 1:910 MAIN RD
Practice Address - Street 2:BOX 22
Practice Address - City:WASHINGTON ISLAND
Practice Address - State:WI
Practice Address - Zip Code:54246-9004
Practice Address - Country:US
Practice Address - Phone:920-847-3093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008554152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0346350001Medicare NSC
ILU45478Medicare UPIN
IL5797390001Medicare NSC
IL759791Medicare PIN