Healthcare Provider Details

I. General information

NPI: 1265720247
Provider Name (Legal Business Name): SHANE MICHAEL RAGSDALE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 N LOCUST ST
DENTON TX
76201-4128
US

IV. Provider business mailing address

526 N LOCUST ST
DENTON TX
76201-4128
US

V. Phone/Fax

Practice location:
  • Phone: 940-387-9595
  • Fax: 940-387-0605
Mailing address:
  • Phone: 940-387-9595
  • Fax: 940-387-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3149
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number7723TG
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7723TG
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number7723TG
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number7723TG
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number7723TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: