MEDICARE: KEVIN JAMES RITTER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2004	NC
2	152W00000X	Optometrist	0618001487	VA
3	152W00000X	Optometrist	2593	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	093UM	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1801870118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN JAMES RITTER O.D.

Provider Business Mailing Address
First Line	:	320 S CHURTON ST
Second Line	:
City	:	HILLSBOROUGH
State	:	NC
Zip	:	27278-2509
Country	:	US
Telephone Number	:	919-732-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 S CHURTON ST
Second Line	:
City	:	HILLSBOROUGH
State	:	NC
Zip	:	27278-2509
Country	:	US
Telephone Number	:	919-732-5000
Fax Number	:	919-732-6855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	04/25/2012

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