MEDICARE: RANDOLPH LYONS OFFUTT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	19201	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194795435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDOLPH LYONS OFFUTT M.D.

Provider Business Mailing Address
First Line	:	101 MEDICAL HEIGHTS DR
Second Line	:	SUITE B
City	:	FRANKFORT
State	:	KY
Zip	:	40601-4137
Country	:	US
Telephone Number	:	502-227-4828
Fax Number	:	502-227-3073

Provider Business Practice Location Address
First Line	:	101 MEDICAL HEIGHTS DR
Second Line	:	SUITE B
City	:	FRANKFORT
State	:	KY
Zip	:	40601-4137
Country	:	US
Telephone Number	:	502-227-4828
Fax Number	:	502-227-3073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	01/07/2010

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