Provider Demographics
NPI:1134230543
Name:RISTOW, DARWIN DALE (OD)
Entity type:Individual
Prefix:DR
First Name:DARWIN
Middle Name:DALE
Last Name:RISTOW
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 1:1273 PARTRIDGE POINT RD
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-5106
Mailing Address - Country:US
Mailing Address - Phone:989-354-3569
Mailing Address - Fax:
Practice Address - Street 1:2578 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4618
Practice Address - Country:US
Practice Address - Phone:989-354-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002206152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0224470001Medicare ID - Type UnspecifiedFOR HARDWARE/GLASSES & FR
MI0Z 46500Medicare ID - Type UnspecifiedUSED FOR EYE EXAMINATIONS