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General NPI Number Information
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NPI Number | 1942227756
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Entity Type | Individual
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Provider Name | RANDAL EUGENE MINOR CERTIFIED OCULARIST
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Gender | Male
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 17817 GUNN HWY
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City | ODESSA
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State | FL
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Zip | 33556-1967
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Country | US
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Telephone | 813-949-2500
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Fax | 813-345-8488
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Provider Business Mailing Address
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Address Line | 17817 GUNN HWY
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City | ODESSA
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State | FL
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Zip | 33556-1967
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Country | US
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Telephone | 813-949-2500
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Fax | 813-345-8488
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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 | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | FL
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