Provider Demographics
NPI:1811184476
Name:COLE, RANDALL A
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:A
Last Name:COLE
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 1:640 COWPATH RD
Mailing Address - Street 2:106
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1563
Mailing Address - Country:US
Mailing Address - Phone:215-368-4900
Mailing Address - Fax:215-368-1058
Practice Address - Street 1:640 COWPATH RD
Practice Address - Street 2:106
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1563
Practice Address - Country:US
Practice Address - Phone:215-368-4900
Practice Address - Fax:215-368-1058
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician