Provider Demographics
NPI:1801870118
Name:RITTER, KEVIN JAMES (OD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:RITTER
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 1:320 S CHURTON ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-2509
Mailing Address - Country:US
Mailing Address - Phone:919-732-5000
Mailing Address - Fax:
Practice Address - Street 1:320 S CHURTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2509
Practice Address - Country:US
Practice Address - Phone:919-732-5000
Practice Address - Fax:919-732-6855
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004152W00000X
VA0618001487152W00000X
TN2593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903112Medicaid
NC093UMOtherBCBS