MEDICARE: MISS PAMELA ALISA RAGSDALE 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	2387	CO

General Provider Information

NPI Number	:	1205897550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PAMELA ALISA RAGSDALE O.D.

Provider Business Mailing Address
First Line	:	4646 CROW CREEK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-4616
Country	:	US
Telephone Number	:	719-200-4465
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 E WOODMEN RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3326
Country	:	US
Telephone Number	:	719-277-0992
Fax Number	:	719-277-0989

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	07/20/2013

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