Healthcare Provider Details

I. General information

NPI: 1265194443
Provider Name (Legal Business Name): JOHN RANDALL TRAWNIK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 GREENVILLE AVE STE 240
DALLAS TX
75206-5037
US

IV. Provider business mailing address

4600 GREENVILLE AVE STE 240
DALLAS TX
75206-5037
US

V. Phone/Fax

Practice location:
  • Phone: 214-739-5355
  • Fax:
Mailing address:
  • Phone: 214-739-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name: JOHN RANDALL TRAWNIK
Title or Position: OWNER
Credential: B.C.O.
Phone: 214-739-5355