Healthcare Provider Details

I. General information

NPI: 1174551543
Provider Name (Legal Business Name): KATHY RITTER GONZALEZ O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 VESTA AVE STE 2
NORTHFIELD OH
44067-2081
US

IV. Provider business mailing address

PO BOX 207170
DALLAS TX
75320-7173
US

V. Phone/Fax

Practice location:
  • Phone: 330-468-0585
  • Fax:
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4383/T289
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: