Provider Demographics
NPI:1790734663
Name:RIDDER, KENNETH D (OD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:D
Last Name:RIDDER
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 1:934 COUNTRYBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-1810
Mailing Address - Country:US
Mailing Address - Phone:303-794-2433
Mailing Address - Fax:303-751-2020
Practice Address - Street 1:200 W COUNTY LINE RD
Practice Address - Street 2:150
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2360
Practice Address - Country:US
Practice Address - Phone:303-794-2433
Practice Address - Fax:303-751-2020
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MR0016887OtherDEA
A0398Medicare ID - Type Unspecified
MR0016887OtherDEA