Provider Demographics
NPI:1588649628
Name:RITTER, KARISA (OD)
Entity Type:Individual
Prefix:
First Name:KARISA
Middle Name:
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 1:336 W FRONT ST
Mailing Address - Street 2:146
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2204
Mailing Address - Country:US
Mailing Address - Phone:231-941-7788
Mailing Address - Fax:231-941-7788
Practice Address - Street 1:4164 E BLUE GRASS RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-7967
Practice Address - Country:US
Practice Address - Phone:989-772-9481
Practice Address - Fax:989-772-5431
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKR004202152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4536546Medicaid
U96599Medicare UPIN
MI4536546Medicaid