Provider Demographics
NPI:1568438372
Name:COX, RANDALL BRUCE (OD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:BRUCE
Last Name:COX
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 1:810 HURST ST
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-3417
Mailing Address - Country:US
Mailing Address - Phone:915-204-4062
Mailing Address - Fax:936-591-0876
Practice Address - Street 1:810 HURST ST
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-3417
Practice Address - Country:US
Practice Address - Phone:915-204-4062
Practice Address - Fax:936-591-0876
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01893TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151055401Medicaid
TX83859EMedicare ID - Type Unspecified
TXTXB116326Medicare PIN
TX151055401Medicaid