Provider Demographics
NPI:1982690566
Name:HUGHES, RANDAL K (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:K
Last Name:HUGHES
Suffix:
Gender:M
Credentials:MD
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 549
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-0549
Mailing Address - Country:US
Mailing Address - Phone:260-569-9550
Mailing Address - Fax:260-569-0760
Practice Address - Street 1:7747 W JEFFERSON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-459-8444
Practice Address - Fax:260-459-8443
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30120207W00000X
IL036093071207W00000X
IN01039469207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000108303OtherANTHEM
289993OtherHEALTHLINK
IN200094570Medicaid
5984162OtherAETNA
KY64301203Medicaid
ILL59644Medicare ID - Type Unspecified
INM400034048Medicare PIN
IN452570022Medicare PIN
180025349Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KY64301203Medicaid
F72292Medicare UPIN
INM400037148Medicare PIN
INP00968268Medicare PIN
000000108303OtherANTHEM
838920DMedicare ID - Type Unspecified