MEDICARE: JOHN RANDALL TRAWNIK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	156FX1700X	Ocularist

General Provider Information

NPI Number	:	1265194443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN RANDALL TRAWNIK

Provider Business Mailing Address
First Line	:	4600 GREENVILLE AVE STE 240
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5037
Country	:	US
Telephone Number	:	214-739-5355
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 GREENVILLE AVE STE 240
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5037
Country	:	US
Telephone Number	:	214-739-5355
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN RANDALL TRAWNIK
Credential	:	B.C.O.
Telephone Number	:	214-739-5355

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	09/20/2022

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