Individual
TIM R RIDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2701 N MAIN ST, HUTCHINSON, KS 67502-3479
(620) 663-8700
(620) 663-8713
Mailing address
1851 N WEBB RD, ATTN FLR2, WICHITA, KS 67206-3413
(316) 636-2010
(316) 858-3830
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
13853
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100219360B
—
KS
01
—
P00292520
RAILROAD MEDICARE
KS
Enumeration date
03/01/2006
Last updated
12/05/2013
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