Provider Demographics
NPI:1265720247
Name:RAGSDALE, SHANE MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:MICHAEL
Last Name:RAGSDALE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:526 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4128
Mailing Address - Country:US
Mailing Address - Phone:940-387-9595
Mailing Address - Fax:940-387-0605
Practice Address - Street 1:526 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4128
Practice Address - Country:US
Practice Address - Phone:940-387-9595
Practice Address - Fax:940-387-0605
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3149152W00000X
TX7723TG152WP0200X, 152W00000X, 152WX0102X, 152WS0006X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision