Provider Demographics
NPI:1265777080
Name:CHILDERS, RANDALL ARTHUR
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:ARTHUR
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RANDALL
Other - Middle Name:ARTHUR
Other - Last Name:CHILDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5034 KEANE DR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6046
Mailing Address - Country:US
Mailing Address - Phone:916-481-3367
Mailing Address - Fax:
Practice Address - Street 1:5034 KEANE DR
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6046
Practice Address - Country:US
Practice Address - Phone:916-481-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30727207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology