MEDICARE: DR. CASANDRA RANDAL OD

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	TUV009663-01	NY

General Provider Information

NPI Number	:	1841915840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASANDRA RANDAL OD

Provider Business Mailing Address
First Line	:	238 E 33RD ST APT 19
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-4844
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2046 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3216
Country	:	US
Telephone Number	:	718-691-5980
Fax Number	:

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

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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