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General NPI Number Information
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NPI Number | 1477525053
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Entity Type | Individual
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Provider Name | RICHARD KEITH DITTO O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 6934 GREEN OAKS RD
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City | FORT WORTH
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State | TX
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Zip | 76116-1715
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Country | US
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Telephone | 817-738-9301
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Fax | 817-738-0773
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Provider Business Mailing Address
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Address Line | 1201 SUMMIT AVE
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City | FORT WORTH
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State | TX
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Zip | 76102-4413
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Country | US
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Telephone | 817-738-9301
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Fax | 817-738-0773
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2229TG
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License Number State | TX
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