Provider Demographics
NPI:1578647988
Name:RAGSDALE, VINCENT K (OD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:K
Last Name:RAGSDALE
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 1:3674 SUNNYSIDE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2414
Mailing Address - Country:US
Mailing Address - Phone:951-529-9000
Mailing Address - Fax:951-684-4440
Practice Address - Street 1:3674 SUNNYSIDE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2414
Practice Address - Country:US
Practice Address - Phone:951-684-4646
Practice Address - Fax:951-684-4440
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10009T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0100090Medicaid
CASD0100090Medicaid
CACU811AMedicare PIN
CA931098680Medicare ID - Type UnspecifiedFEIN
CA330595692Medicare UPIN