Individual
DR. JOHN T RIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1616 19TH AVE, LEWISTON, ID 83501-4005
(208) 746-3626
(208) 746-1636
Mailing address
1616 19TH AVE, PO BOX 1104, LEWISTON, ID 83501-4005
(208) 746-3626
(208) 746-1636
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-831
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004322700
—
ID
05
—
2012219
—
WA
Enumeration date
06/22/2006
Last updated
11/05/2009
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