Provider Demographics
NPI:1710017587
Name:RITTER, LARRY WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WAYNE
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 1:6113 INDIAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3503
Mailing Address - Country:US
Mailing Address - Phone:757-420-2053
Mailing Address - Fax:757-424-9503
Practice Address - Street 1:6113 INDIAN RIVER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3503
Practice Address - Country:US
Practice Address - Phone:757-420-2053
Practice Address - Fax:757-424-9503
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002166152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710017587Medicaid
ME410011944OtherRAILROAD MEDICARE
ME000379OtherBC & BS
ME0468580001OtherMEDICARE DMEPOS
ME0468580001OtherMEDICARE DMEPOS