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General NPI Number Information
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NPI Number | 1790734663
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Entity Type | Individual
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Provider Name | KENNETH D RIDDER O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 200 W COUNTY LINE RD 150
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-2360
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Country | US
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Telephone | 303-794-2433
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Fax | 303-751-2020
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Provider Business Mailing Address
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Address Line | 934 COUNTRYBRIAR LN
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-1810
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Country | US
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Telephone | 303-794-2433
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Fax | 303-751-2020
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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 | 1566
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License Number State | CO
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