Provider Demographics
NPI:1841206794
Name:RANDALL, JOHN GILBERT III (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GILBERT
Last Name:RANDALL
Suffix:III
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 1:2306 N TRAVIS ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-2517
Mailing Address - Country:US
Mailing Address - Phone:903-892-4292
Mailing Address - Fax:903-893-8734
Practice Address - Street 1:2306 N TRAVIS ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2517
Practice Address - Country:US
Practice Address - Phone:903-892-4292
Practice Address - Fax:903-893-8734
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5449TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU68581Medicare UPIN
TX00011EMedicare ID - Type Unspecified