Healthcare Provider Details

I. General information

NPI: 1174719967
Provider Name (Legal Business Name): SHANE RAGSDALE O.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
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 Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number7723-TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number7723-TG
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number7723-TG
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7723-TG
License Number StateTX

VIII. Authorized Official

Name: DR. SHANE RAGSDALE
Title or Position: OWNER/PRESIDENT
Credential: O.D.
Phone: 940-387-9595