Provider Demographics
NPI:1104898162
Name:RANDALL T PARRISH JR OD PA
Entity type:Organization
Organization Name:RANDALL T PARRISH JR OD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:T
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:863-675-0761
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC 1494OtherCIGNA
FL99715OtherBLUE CROSS BLUE SHIELD
CF9406OtherRAILROAD
FLOPC1494OtherUNITED HEALTHCARE
FL078861900Medicaid
=========OtherTRICARE
FLOPC 1494OtherCIGNA
=========OtherCOMMERCIAL INSURANCE
FL0569010001Medicare NSC