=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316940414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RANDAL E. MARCH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2005
-----------------------------------------------------
Last Update Date | 09/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6770 MAYFIELD RD # 338
-----------------------------------------------------
City | MAYFIELD HTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124-2299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-442-4330
-----------------------------------------------------
Fax | 440-442-4695
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6770 MAYFIELD RD # 338
-----------------------------------------------------
City | MAYFIELD HTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124-2299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-442-4330
-----------------------------------------------------
Fax | 440-442-4695
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 35-04-9627-M
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------