Provider Demographics
NPI:1629014931
Name:RITCHIE, KENNETH KIRK (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:KIRK
Last Name:RITCHIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2459
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96160-2459
Mailing Address - Country:US
Mailing Address - Phone:530-582-3666
Mailing Address - Fax:530-582-3668
Practice Address - Street 1:10956 DONNER PASS RD
Practice Address - Street 2:120
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4861
Practice Address - Country:US
Practice Address - Phone:530-582-3666
Practice Address - Fax:530-582-3668
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31137207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44664Medicare UPIN