Provider Demographics
NPI:1033173505
Name:RITCHIE, DAVID H (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:RITCHIE
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 1:150 S JEFFERSON ST SE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-3420
Mailing Address - Country:US
Mailing Address - Phone:478-452-1323
Mailing Address - Fax:478-452-2825
Practice Address - Street 1:150 S JEFFERSON ST SE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-3420
Practice Address - Country:US
Practice Address - Phone:478-452-1323
Practice Address - Fax:478-452-2825
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000987152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000261643AMedicaid
GA202I413127Medicare PIN
GA000261643AMedicaid