NPIMap

Organization Active NPI

John T Rietz

Doing business as Optometric Vision Center

  • Optometrist
  • Lewiston, ID
National Provider Identifier
1306967120
Registry record updated Nov 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
JOHN T RIETZ
Doing business as
Optometric Vision Center
Practice address
1616 19TH Ave
Lewiston, ID 83501-4005
Phone
(208) 746-3626
Fax
(208) 746-1636
NPI assigned
Apr 2, 2007
Last updated
Nov 5, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John T Rietz, ODNPI 1821024050
Title
Optometrist
Phone
(208) 746-3626

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

1616 19TH Ave
Lewiston, ID 83501-4005

Mailing address

1616 19TH Ave
Lewiston, ID 83501-4005
Phone (208) 746-3626

Other identifiers 2

IdentifierTypeStateIssuer
002674300MedicaidID
2012219MedicaidWA

Other names 1

  • OPTOMETRIC VISION CENTER Doing business as

National Provider Directory

National Provider Directory

Locations

1616 19th Ave
Lewiston, ID 83501
Phone (208) 746-3626

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257379200000",
    "number": "1306967120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 19TH AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014005",
            "telephone_number": "208-746-3626",
            "fax_number": "208-746-1636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 19TH AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014005",
            "telephone_number": "208-746-3626",
            "fax_number": "208-746-1636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN T RIETZ",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2009-11-05",
        "status": "A",
        "authorized_official_last_name": "RIETZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "208-746-3626",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002674300",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2012219",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OPTOMETRIC VISION CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lewiston, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.