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General NPI Number Information
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NPI Number | 1871767814
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Entity Type | Organization
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Legal Business Name | JOHN G RANDALL
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 2306 N TRAVIS ST
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City | SHERMAN
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State | TX
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Zip | 75092-2517
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Country | US
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Telephone | 903-892-4292
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Fax | 903-893-8734
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Provider Business Mailing Address
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Address Line | 2306 N TRAVIS ST
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City | SHERMAN
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State | TX
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Zip | 75092-2517
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Country | US
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Telephone | 903-892-4292
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Fax | 903-893-8734
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JOHN G RANDALL
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Credential | O.D.
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Telephone | 903-892-4292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 5449TG
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License Number State | TX
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