Provider Demographics
NPI:1073625224
Name:DAVIDSON, RON GLENN (OD)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:GLENN
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 SOUTH HULEN STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1930
Mailing Address - Country:US
Mailing Address - Phone:817-738-2027
Mailing Address - Fax:817-738-5440
Practice Address - Street 1:3000 SOUTH HULEN STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1930
Practice Address - Country:US
Practice Address - Phone:817-738-2027
Practice Address - Fax:817-738-5440
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2361TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV0100218OtherDPS
TXV0100218OtherDPS
TXV0100218OtherDPS