Provider Demographics
NPI:1538509351
Name:RATCLIFF, REAGAN M (OD)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:M
Last Name:RATCLIFF
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 1:105 E PARKWOOD AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5177
Mailing Address - Country:US
Mailing Address - Phone:281-648-1910
Mailing Address - Fax:281-648-1929
Practice Address - Street 1:105 E PARKWOOD AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5177
Practice Address - Country:US
Practice Address - Phone:281-648-1910
Practice Address - Fax:281-648-1929
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8148-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8148-TOtherOPTOMETRY LICENSE
TX31650YU4FMedicare PIN