Healthcare Provider Details

I. General information

NPI: 1164621330
Provider Name (Legal Business Name): JOHN CARLTON RANDOLPH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 OAKWATER CIR
ORLANDO FL
32806-6263
US

IV. Provider business mailing address

3824 OAKWATER CIR
ORLANDO FL
32806-6263
US

V. Phone/Fax

Practice location:
  • Phone: 800-255-7188
  • Fax: 407-425-7188
Mailing address:
  • Phone: 407-425-7188
  • Fax: 407-423-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME119936
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME119936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: