Provider Demographics
NPI:1528021276
Name:BAUGHMAN, RANDALL (OD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:BAUGHMAN
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 1:1609 WOODRUFF ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5928
Mailing Address - Country:US
Mailing Address - Phone:864-288-7445
Mailing Address - Fax:864-288-8288
Practice Address - Street 1:1609 WOODRUFF ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5928
Practice Address - Country:US
Practice Address - Phone:864-288-7445
Practice Address - Fax:864-288-8288
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC-1041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD10414Medicaid
SC0638200001Medicare NSC
SCD10414Medicaid
SC7202Medicare PIN