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General NPI Number Information
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NPI Number | 1962617464
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Entity Type | Individual
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Provider Name | RANDALL EARL CONRAD O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12845 POWAY RD STE. 209
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City | POWAY
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State | CA
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Zip | 92064-4529
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Country | US
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Telephone | 858-748-6210
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Fax | 858-748-6224
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Provider Business Mailing Address
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Address Line | 472 NILA
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City | POWAY
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State | CA
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Zip | 92020
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Country | US
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Telephone | 619-444-7269
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Fax | 858-748-6224
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 6423T
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License Number State | CA
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