Provider Demographics
NPI:1578592689
Name:POHLENZ, RANDALL ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:ALAN
Last Name:POHLENZ
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 1:2144 SW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-2554
Mailing Address - Country:US
Mailing Address - Phone:785-266-1515
Mailing Address - Fax:785-266-2441
Practice Address - Street 1:2144 SW 36TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2554
Practice Address - Country:US
Practice Address - Phone:785-266-1515
Practice Address - Fax:785-266-2441
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1272-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS410037231OtherRAILROAD MEDICARE
KS052594OtherMEDICARE
KS100218330BMedicaid
KST71338Medicare UPIN
KS100218330BMedicaid
KS052594OtherMEDICARE