Healthcare Provider Details

I. General information

NPI: 1194878520
Provider Name (Legal Business Name): DELBERT C RITCHEY JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 WALNUT ST PEARLE VISION
PHILADELPHIA PA
19102-3604
US

IV. Provider business mailing address

1528 WALNUT ST PEARLE VISION
PHILADELPHIA PA
19102-3604
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-7622
  • Fax: 215-732-7626
Mailing address:
  • Phone: 215-732-7622
  • Fax: 215-732-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000741
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: