MEDICARE: DR. RICHARD KEITH DITTO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2229TG	TX

General Provider Information

NPI Number	:	1477525053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD KEITH DITTO O.D.

Provider Business Mailing Address
First Line	:	1201 SUMMIT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-4413
Country	:	US
Telephone Number	:	817-738-9301
Fax Number	:	817-738-0773

Provider Business Practice Location Address
First Line	:	6934 GREEN OAKS RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1715
Country	:	US
Telephone Number	:	817-738-9301
Fax Number	:	817-738-0773

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	11/20/2018

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