Provider Demographics
NPI:1104898154
Name:PARRISH, RANDALL T JR (OD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:T
Last Name:PARRISH
Suffix:JR
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 1:100 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-7000
Mailing Address - Country:US
Mailing Address - Phone:863-675-0761
Mailing Address - Fax:863-675-3518
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-7000
Practice Address - Country:US
Practice Address - Phone:863-675-0761
Practice Address - Fax:863-675-3518
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPC1494OtherTRICARE
FL078209200Medicaid
OPC 1494OtherCIGNA
OPC1494OtherUNITED HEALTHCARE
FL19189OtherBCBS
FLOPC1494OtherCOMMERCIAL INSURANCE
FL0569010001Medicare NSC
FL19189ZMedicare PIN
OPC1494OtherTRICARE
580002909Medicare ID - Type UnspecifiedRAILROAD