Provider Demographics
NPI:1134120371
Name:KARDON, RANDY H (MD PH D)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:H
Last Name:KARDON
Suffix:
Gender:M
Credentials:MD PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2260
Mailing Address - Fax:319-353-7996
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2260
Practice Address - Fax:319-353-7996
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23796207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24411OtherWELLMARK BCBS
IA0244111Medicaid
IA24411OtherWELLMARK BCBS
IA0244111Medicaid