Provider Demographics
NPI:1184619140
Name:RIDENOUR, CHESTER DUANE (DO)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:DUANE
Last Name:RIDENOUR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 NEIL AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7310
Mailing Address - Country:US
Mailing Address - Phone:614-464-3937
Mailing Address - Fax:614-464-0088
Practice Address - Street 1:262 NEIL AVE STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7310
Practice Address - Country:US
Practice Address - Phone:614-464-3937
Practice Address - Fax:614-464-0088
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003283R207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180028607OtherRAILROAD MEDICARE
OH0812571Medicaid
RI0742323Medicare PIN
OH0812571Medicaid
RI0742324Medicare PIN