Provider Demographics
NPI:1255418802
Name:RITTER, HEATHER (OD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RITTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 115TH ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5585
Mailing Address - Country:US
Mailing Address - Phone:715-834-1737
Mailing Address - Fax:
Practice Address - Street 1:4300 RIB MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-6604
Practice Address - Country:US
Practice Address - Phone:715-241-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3060-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000047651OtherMEDICARE PROVIDER NUMBER