Provider Demographics
NPI:1538130208
Name:RITTER, JULIE P (OD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:P
Last Name:RITTER
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 1:5959 LAWNDALE ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2921
Mailing Address - Country:US
Mailing Address - Phone:231-845-6261
Mailing Address - Fax:231-843-9171
Practice Address - Street 1:5959 LAWNDALE ST
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2921
Practice Address - Country:US
Practice Address - Phone:231-845-6261
Practice Address - Fax:231-843-9171
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI003672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4546453Medicaid
MI4921616Medicaid
MI900F410030OtherBCBS OF MICHIGAN
MI900E300160OtherBLUE CROSS BLUE SHIELD OF MI
P00081892OtherRAILROAD MEDICARE
MI4172685Medicaid
MI4921616Medicaid
MI4546453Medicaid