Provider Demographics
NPI:1720001738
Name:MCPHERRAN, RANDALL RAY (OD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:RAY
Last Name:MCPHERRAN
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 1:6283 CLARK RD
Mailing Address - Street 2:#10
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4100
Mailing Address - Country:US
Mailing Address - Phone:530-877-2020
Mailing Address - Fax:530-877-4146
Practice Address - Street 1:6283 CLARK RD
Practice Address - Street 2:#10
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4100
Practice Address - Country:US
Practice Address - Phone:530-877-2020
Practice Address - Fax:530-877-4146
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9153TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0091530Medicaid
CASD0091531Medicare ID - Type Unspecified
CASD0091530Medicaid