Provider Demographics
NPI:1558125567
Name:CAGLE, KERRY RYAN
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:RYAN
Last Name:CAGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 US HIGHWAY 380
Mailing Address - Street 2:
Mailing Address - City:CROSS ROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-4642
Mailing Address - Country:US
Mailing Address - Phone:940-488-7013
Mailing Address - Fax:940-365-9137
Practice Address - Street 1:11700 US HIGHWAY 380
Practice Address - Street 2:
Practice Address - City:CROSS ROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-4642
Practice Address - Country:US
Practice Address - Phone:940-488-7013
Practice Address - Fax:940-365-9137
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245083156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician