Basic Information
| Provider Information | |||||||||
| NPI: | 1760566319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RITTENHOUSE | ||||||||
| FirstName: | LANCE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1009 | ||||||||
| Address2: | |||||||||
| City: | STATESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304591009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127649147 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3440 WRIGHTSBORO RD | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309092511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067330020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 07/09/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT002553 | GA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.