Provider Demographics
NPI:1770607681
Name:KIRKBRIDE, RANDALL
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:KIRKBRIDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 MAYSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9604
Mailing Address - Country:US
Mailing Address - Phone:740-453-3937
Mailing Address - Fax:740-453-1010
Practice Address - Street 1:2928 MAYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-9604
Practice Address - Country:US
Practice Address - Phone:740-453-3937
Practice Address - Fax:740-453-1010
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1380SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician