Active NPI
Ron Glenn Davidson, OD
- Optometrist
- Fort Worth, TX
National Provider Identifier
1073625224
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2361TG
- Practice address
- 3000 South Hulen Street
Suite 104
Fort Worth, TX 76109-1930 - Phone
- (817) 738-2027
- Fax
- (817) 738-5440
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2361TG | TX | Primary |
Addresses
Primary practice location
3000 South Hulen Street
Suite 104
Fort Worth, TX 76109-1930
Mailing address
3000 South Hulen Street
Suite 104
Fort Worth, TX 76109-1930
Phone (817) 738-2027
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| V0100218 | Other | TX | DPS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2361TG | TX | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1073625224",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 SOUTH HULEN STREET",
"address_2": "SUITE 104",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761091930",
"telephone_number": "817-738-2027",
"fax_number": "817-738-5440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 SOUTH HULEN STREET",
"address_2": "SUITE 104",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761091930",
"telephone_number": "817-738-2027",
"fax_number": "817-738-5440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "RON",
"middle_name": "GLENN",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "2361TG",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DPS",
"identifier": "V0100218",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.