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General NPI Number Information
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NPI Number | 1083574917
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Entity Type | Individual
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Provider Name | RANDY JAMES CAMMACK LDO
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Gender | Male
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 1099 INDIAN DR
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City | EASTMAN
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State | GA
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Zip | 31023-7663
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Country | US
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Telephone | 478-374-3134
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 649
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City | MOUNT VERNON
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State | GA
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Zip | 30445-0649
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | LDO002679
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License Number State | GA
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