Provider Demographics
NPI:1740460039
Name:RANDAL H PAUL PSC
Entity type:Organization
Organization Name:RANDAL H PAUL PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DISHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-842-6300
Mailing Address - Street 1:1332 ANDREA ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3334
Mailing Address - Country:US
Mailing Address - Phone:270-842-6300
Mailing Address - Fax:270-842-6303
Practice Address - Street 1:1332 ANDREA ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3334
Practice Address - Country:US
Practice Address - Phone:270-842-6300
Practice Address - Fax:270-842-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29638207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYE82360Medicare UPIN
KY0754001Medicare PIN
KY1535101Medicare PIN
KY00469001Medicare PIN
1537029Medicare PIN
KY4881520001Medicare NSC