Healthcare Provider Details

I. General information

NPI: 1376807214
Provider Name (Legal Business Name): RANDALL NOAH STEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 JOE KNOX AVE
MOORESVILLE NC
28117-9169
US

IV. Provider business mailing address

PO BOX 60160
CHARLOTTE NC
28260-0160
US

V. Phone/Fax

Practice location:
  • Phone: 704-658-2321
  • Fax: 704-235-1878
Mailing address:
  • Phone: 704-365-0555
  • Fax: 704-367-8120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number2016-00669
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2016-00669
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: