Provider Demographics
NPI:1093011033
Name:CHEEK, RANDAL L (DPO0000000487)
Entity Type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:L
Last Name:CHEEK
Suffix:
Gender:M
Credentials:DPO0000000487
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1922 SHADY BROOK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3989
Mailing Address - Country:US
Mailing Address - Phone:931-388-2061
Mailing Address - Fax:931-388-9973
Practice Address - Street 1:1922 SHADY BROOK ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3989
Practice Address - Country:US
Practice Address - Phone:931-388-2061
Practice Address - Fax:931-388-9973
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPO0000000487156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician