Provider Demographics
NPI:1629045448
Name:RIDDER, GINA C (OD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:C
Last Name:RIDDER
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 1:1851 N WEBB RD
Mailing Address - Street 2:ATTN FLR2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3413
Mailing Address - Country:US
Mailing Address - Phone:316-636-2010
Mailing Address - Fax:316-858-3830
Practice Address - Street 1:2701 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-3479
Practice Address - Country:US
Practice Address - Phone:620-663-8700
Practice Address - Fax:620-663-8713
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219380CMedicaid
KSCD2825OtherRAILROAD MEDICARE GROUP ID
KSP00457707OtherRAIL ROAD MEDICARE PTAN
KSP00457707OtherRAIL ROAD MEDICARE PTAN
KSCD2825OtherRAILROAD MEDICARE GROUP ID