Healthcare Provider Details

I. General information

NPI: 1801870118
Provider Name (Legal Business Name): KEVIN JAMES RITTER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S CHURTON ST
HILLSBOROUGH NC
27278-2509
US

IV. Provider business mailing address

320 S CHURTON ST
HILLSBOROUGH NC
27278-2509
US

V. Phone/Fax

Practice location:
  • Phone: 919-732-5000
  • Fax: 919-732-6855
Mailing address:
  • Phone: 919-732-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2004
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001487
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2593
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: