Provider Demographics
NPI:1154433357
Name:RAGAN, RUSSELL TODD (OD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:TODD
Last Name:RAGAN
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 1:3524 STATE ROUTE 160
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-9681
Mailing Address - Country:US
Mailing Address - Phone:740-446-2236
Mailing Address - Fax:740-446-9883
Practice Address - Street 1:3524 STATE ROUTE 160
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-9681
Practice Address - Country:US
Practice Address - Phone:740-446-2236
Practice Address - Fax:740-446-9883
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4488152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0995722Medicaid
OHRA0735273Medicare ID - Type Unspecified