Provider Demographics
NPI:1639749401
Name:RITCHHART, LOGAN EUGENE
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:EUGENE
Last Name:RITCHHART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42719-0297
Mailing Address - Country:US
Mailing Address - Phone:270-469-4393
Mailing Address - Fax:270-469-1050
Practice Address - Street 1:68 WELLNESS LN
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-7650
Practice Address - Country:US
Practice Address - Phone:270-469-4393
Practice Address - Fax:270-469-1050
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2250DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist