Provider Demographics
NPI:1114011772
Name:RITCHEY, MARY FRANCES (OD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES
Last Name:RITCHEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 LILIHA STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817
Mailing Address - Country:US
Mailing Address - Phone:808-524-1010
Mailing Address - Fax:808-531-1030
Practice Address - Street 1:1712 LILIHA STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-524-1010
Practice Address - Fax:808-531-1030
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD 438152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI20915-5OtherHMSA PROVIDER #
HI7979301Medicaid
HIT991397Medicare UPIN
HI7979301Medicaid