MEDICARE: DR. RANDALL ALAN LITTELL O.D.

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	152W00000X	Optometrist	OD854	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2240225	OTHER	TN	UNITED HEALTHCARE
2	48248	OTHER	TN	BCBS NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922193341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL ALAN LITTELL O.D.

Provider Business Mailing Address
First Line	:	PO BOX 849
Second Line	:
City	:	TRACY CITY
State	:	TN
Zip	:	37387-0849
Country	:	US
Telephone Number	:	931-592-2868
Fax Number	:	931-592-2875

Provider Business Practice Location Address
First Line	:	97 ST CLAIR ST
Second Line	:
City	:	TRACY CITY
State	:	TN
Zip	:	37387-1437
Country	:	US
Telephone Number	:	931-592-2868
Fax Number	:	931-592-2875

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	02/06/2024

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