Provider Demographics
NPI:1093199192
Name:RABON, RANDAL J II (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:J
Last Name:RABON
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:RANDAL
Other - Middle Name:J
Other - Last Name:RABON
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:510 N MAIN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1393
Mailing Address - Country:US
Mailing Address - Phone:423-743-3128
Mailing Address - Fax:423-743-3129
Practice Address - Street 1:114 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-1308
Practice Address - Country:US
Practice Address - Phone:423-460-1567
Practice Address - Fax:423-460-1645
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD3261152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist