Provider Demographics
NPI:1639111545
Name:KANE, RANDALL H (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:H
Last Name:KANE
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 1:152 LEADLINE LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8480
Mailing Address - Country:US
Mailing Address - Phone:610-455-0133
Mailing Address - Fax:610-644-6404
Practice Address - Street 1:32 W KING ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2493
Practice Address - Country:US
Practice Address - Phone:610-644-1879
Practice Address - Fax:610-644-6404
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA58000147OtherRAILROAD MEDICARE
PA58000147OtherRAILROAD MEDICARE
PA407815Medicare UPIN