Provider Demographics
NPI:1881684678
Name:RITZ, NICHOLAS B (OD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:B
Last Name:RITZ
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 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:5200 EUBANK BLVD NE
Practice Address - Street 2:SUITE A-4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1759
Practice Address - Country:US
Practice Address - Phone:505-298-4419
Practice Address - Fax:505-298-0878
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00P249OtherBC BS OF NM
AZ447913Medicaid
NMZ0401Medicaid
AZ447913Medicaid
NMZ0401Medicaid