Provider Demographics
NPI:1083607717
Name:THOMAS, RANDALL K (OD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:K
Last Name:THOMAS
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 1:201 LE PHILLIP CT, NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2900
Mailing Address - Country:US
Mailing Address - Phone:704-782-1127
Mailing Address - Fax:704-782-1207
Practice Address - Street 1:201 LE PHILLIP CT, NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2900
Practice Address - Country:US
Practice Address - Phone:704-782-1127
Practice Address - Fax:704-782-1207
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1063152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6196498003OtherCIGNA
NC1934OtherPARTNERS
NC8909892Medicaid
NC9892OtherBLUE CROSS
NC246612GMedicare PIN
NC1934OtherPARTNERS
NC8909892Medicaid