MEDICARE: DR. CARMEN DIANE RAMIREZ-SHANK 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	3679T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386653988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMEN DIANE RAMIREZ-SHANK O.D.

Provider Business Mailing Address
First Line	:	6011 S FLORES ST STE B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2153
Country	:	US
Telephone Number	:	210-924-3994
Fax Number	:	210-924-3941

Provider Business Practice Location Address
First Line	:	6011 S FLORES ST STE B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2153
Country	:	US
Telephone Number	:	210-924-3994
Fax Number	:	210-924-3941

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/10/2014

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Directions to “ DR. CARMEN DIANE RAMIREZ-SHANK O.D.” Practice Location

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