Provider Demographics
NPI:1114958758
Name:RANDLE, STEVE
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:RANDLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821
Mailing Address - Country:US
Mailing Address - Phone:662-256-8481
Mailing Address - Fax:662-256-5276
Practice Address - Street 1:307 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821
Practice Address - Country:US
Practice Address - Phone:662-256-8481
Practice Address - Fax:662-256-5276
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS640715180152W00000X
MS152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS410002688OtherRAILROAD MEDICARE
MS00087048Medicaid
MS477949OtherADVANTRA FREEDOM
MS410002688OtherRAILROAD MEDICARE