Provider Demographics
NPI:1215038898
Name:OMLOR, RANDY A (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:A
Last Name:OMLOR
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 VINTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-5309
Mailing Address - Country:US
Mailing Address - Phone:704-300-2244
Mailing Address - Fax:
Practice Address - Street 1:4907 DALBEY LANE
Practice Address - Street 2:SUITE B
Practice Address - City:BERLIN
Practice Address - State:OH
Practice Address - Zip Code:44610-0224
Practice Address - Country:US
Practice Address - Phone:330-893-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH549240Medicare PIN