Organization Active NPI

Shane Ragsdale O.D. P.a.

  • Optometrist
  • Denton, TX
National Provider Identifier
1174719967
Registry record updated Mar 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7723-TG Issued in TX
Legal business name
SHANE RAGSDALE O.D. P.A.
Practice address
526 N Locust St
Denton, TX 76201-4128
Phone
(940) 387-9595
Fax
(940) 387-0605
NPI assigned
Sep 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Shane Ragsdale, O.D.NPI 1265720247
Title
Owner/President
Phone
(940) 387-9595

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 7723-TG TX Primary
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X 7723-TG TX
Pediatric OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WP0200X 7723-TG TX
Sports Vision OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WS0006X 7723-TG TX

Addresses

Primary practice location

526 N Locust St
Denton, TX 76201-4128

Mailing address

526 N Locust St
Denton, TX 76201-4128
Phone (940) 387-9595

Other identifiers 2

IdentifierTypeStateIssuer
00E35GOtherTXBLUE CROSS BLUE SHIELD
1649550-02MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090327000115 TX Part B Supplier - Clinic/Group Practice 1658438114 Receives reassigned benefits from 6 practitioners
Practice locations: Denton, TX

National Provider Directory

National Provider Directory

Locations

526 N Locust St
Denton, TX 76201
Phone (940) 382-3535

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677715200000",
    "number": "1174719967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 N LOCUST ST",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762014128",
            "telephone_number": "940-387-9595",
            "fax_number": "940-387-0605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 N LOCUST ST",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762014128",
            "telephone_number": "940-387-9595",
            "fax_number": "940-387-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANE RAGSDALE O.D. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-14",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A",
        "authorized_official_last_name": "RAGSDALE",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "940-387-9595",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7723-TG",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "TX",
            "license": "7723-TG",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "TX",
            "license": "7723-TG",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": "TX",
            "license": "7723-TG",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00E35G",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649550-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Denton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.