Provider Demographics
NPI:1386653988
Name:RAMIREZ-SHANK, CARMEN DIANE (OD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:DIANE
Last Name:RAMIREZ-SHANK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 S FLORES ST STE B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2153
Mailing Address - Country:US
Mailing Address - Phone:210-924-3994
Mailing Address - Fax:210-924-3941
Practice Address - Street 1:6011 S FLORES ST STE B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2153
Practice Address - Country:US
Practice Address - Phone:210-924-3994
Practice Address - Fax:210-924-3941
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3679T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0019536401Medicaid
TX0019536401Medicaid
TX00E85UMedicare ID - Type UnspecifiedMEDICARE ID