Provider Demographics
NPI:1043785207
Name:WHITE, RANDAL HARRISON (OD, MPH)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:HARRISON
Last Name:WHITE
Suffix:
Gender:M
Credentials:OD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W WEAVER ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-6009
Mailing Address - Country:US
Mailing Address - Phone:919-968-6300
Mailing Address - Fax:
Practice Address - Street 1:200 W WEAVER ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-6009
Practice Address - Country:US
Practice Address - Phone:919-968-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist