Provider Demographics
NPI:1801918552
Name:MAY, RANDY CHAD (OD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:CHAD
Last Name:MAY
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 684
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-0684
Mailing Address - Country:US
Mailing Address - Phone:205-932-2841
Mailing Address - Fax:205-932-2852
Practice Address - Street 1:3186 HIGHWAY 171 N
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-6172
Practice Address - Country:US
Practice Address - Phone:205-932-2841
Practice Address - Fax:205-932-2852
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001796152W00000X
ALS-925-TA-502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU79609Medicare UPIN
AL102I418500Medicare PIN