Provider Demographics
NPI:1184824658
Name:FRITSCH, RYAN P (OD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:P
Last Name:FRITSCH
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 1:667 S MT. JULIET RD
Mailing Address - Street 2:
Mailing Address - City:MT. JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-6319
Mailing Address - Country:US
Mailing Address - Phone:615-758-2344
Mailing Address - Fax:615-758-8868
Practice Address - Street 1:667 S MT. JULIET RD
Practice Address - Street 2:
Practice Address - City:MT. JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-6319
Practice Address - Country:US
Practice Address - Phone:615-758-2344
Practice Address - Fax:615-758-8868
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist