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General NPI Number Information
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NPI Number | 1194905695
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Entity Type | Organization
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Legal Business Name | RANDY A. OMLOR, OD PA
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 1415 N LAFAYETTE ST
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City | SHELBY
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State | NC
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Zip | 28150-3406
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Country | US
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Telephone | 704-487-4099
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 N LAFAYETTE ST
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City | SHELBY
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State | NC
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Zip | 28150-3406
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Country | US
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Telephone | 704-487-4099
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDY A OMLOR
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Credential | O.D, M.S.
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Telephone | 828-657-0016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2039
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License Number State | NC
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