Provider Demographics
NPI:1154471787
Name:ATWOOD, RANDY CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:CRAIG
Last Name:ATWOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 LEMMON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4332
Mailing Address - Country:US
Mailing Address - Phone:214-219-3393
Mailing Address - Fax:214-443-1862
Practice Address - Street 1:3725 LEMMON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4332
Practice Address - Country:US
Practice Address - Phone:214-219-3393
Practice Address - Fax:214-443-1862
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3439T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2142193393OtherVSP (VISION SERVICE PLAN)
TX51729OtherDAVIS VISION
TX28036OtherSPECTERA
TX3143OtherSUPERIOR VISION
TX2142193393OtherVSP (VISION SERVICE PLAN)