Provider Demographics
NPI:1699835587
Name:RITTER, THOMAS GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GEORGE
Last Name:RITTER
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 1:9912 CARVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5541
Mailing Address - Country:US
Mailing Address - Phone:513-984-0202
Mailing Address - Fax:513-891-2233
Practice Address - Street 1:9912 CARVER RD STE 101
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5541
Practice Address - Country:US
Practice Address - Phone:513-984-0202
Practice Address - Fax:513-891-2233
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0346370Medicaid
OHT46957Medicare UPIN
OH0346370Medicaid