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General NPI Number Information
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NPI Number | 1336315498
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Entity Type | Organization
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Legal Business Name | RANDALL B COX OPTOMETRIC CONSULTANTS PC
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 617 N 1ST ST
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City | GRANTS
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State | NM
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Zip | 87020-2703
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Country | US
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Telephone | 505-287-9438
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Fax | 505-287-9439
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Provider Business Mailing Address
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Address Line | 617 N 1ST ST
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City | GRANTS
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State | NM
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Zip | 87020-2703
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Country | US
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Telephone | 505-287-9438
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Fax | 505-287-9439
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRIST
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Name | RANDALL B COX
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Credential | O.D.
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Telephone | 505-287-9438
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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 | OP2212
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License Number State | NM
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