Healthcare Provider Details

I. General information

NPI: 1639749401
Provider Name (Legal Business Name): LOGAN EUGENE RITCHHART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MAIN ST
BROOKVILLE IN
47012-1363
US

IV. Provider business mailing address

PO BOX 297
CAMPBELLSVILLE KY
42719-0297
US

V. Phone/Fax

Practice location:
  • Phone: 765-547-1325
  • Fax: 765-547-1327
Mailing address:
  • Phone: 270-469-4393
  • Fax: 270-469-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004615
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: