MEDICARE: DR. RANDY CLYDE PIPPIN O.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	152W00000X	Optometrist	955	TN

General Provider Information

NPI Number	:	1760523674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY CLYDE PIPPIN O.D.

Provider Business Mailing Address
First Line	:	1625 E CHURCHILL DOWNS
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-2621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 N GERMANTOWN PKWY
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38133-8149
Country	:	US
Telephone Number	:	901-937-1644
Fax Number	:

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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