Provider Demographics
NPI:1922193341
Name:LITTELL, RANDALL ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:ALAN
Last Name:LITTELL
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:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:TRACY CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37387-0849
Mailing Address - Country:US
Mailing Address - Phone:931-592-2868
Mailing Address - Fax:931-592-2875
Practice Address - Street 1:97 ST CLAIR ST
Practice Address - Street 2:
Practice Address - City:TRACY CITY
Practice Address - State:TN
Practice Address - Zip Code:37387-1437
Practice Address - Country:US
Practice Address - Phone:931-592-2868
Practice Address - Fax:931-592-2875
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD854152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2240225OtherUNITED HEALTHCARE
TN48248OtherBCBS NUMBER
TN3595020Medicaid
TN2240225OtherUNITED HEALTHCARE
TN3595020Medicare ID - Type Unspecified
TNML0101181OtherDEA NUMBER
TN0137020001Medicare NSC
TN0137020002Medicare NSC