Provider Demographics
NPI:1376939975
Name:OXFORD UNIVERSITY EYECARE PLLC
Entity Type:Organization
Organization Name:OXFORD UNIVERSITY EYECARE PLLC
Other - Org Name:RANDLE OPTOMETRIC SERVICES PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-213-3937
Mailing Address - Street 1:2708 W OXFORD LOOP STE 110
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5724
Mailing Address - Country:US
Mailing Address - Phone:662-380-5041
Mailing Address - Fax:662-380-5042
Practice Address - Street 1:2708 W OXFORD LOOP
Practice Address - Street 2:110
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5714
Practice Address - Country:US
Practice Address - Phone:662-213-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS687261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04600368Medicaid
MS02438061Medicaid
MSU91671Medicare UPIN