Provider Demographics
NPI:1841445368
Name:DR. RANDALL L. EDWARDS
Entity type:Organization
Organization Name:DR. RANDALL L. EDWARDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/SELF
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-341-6000
Mailing Address - Street 1:1605 EGLIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6107
Mailing Address - Country:US
Mailing Address - Phone:605-341-6000
Mailing Address - Fax:605-341-6001
Practice Address - Street 1:1605 EGLIN ST
Practice Address - Street 2:STE. 2
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6107
Practice Address - Country:US
Practice Address - Phone:605-341-6000
Practice Address - Fax:605-341-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD466207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty