Provider Demographics
NPI:1154537918
Name:DR. R. TODD RAGAN, INC.
Entity type:Organization
Organization Name:DR. R. TODD RAGAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-446-2236
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4488152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0948590001Medicare NSC