Provider Demographics
NPI:1215995261
Name:LAMBIRTH, RANDALL CARROLL II (OD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:CARROLL
Last Name:LAMBIRTH
Suffix:II
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 1:3221 SUMMIT SQUARE PL STE 200
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2655
Mailing Address - Country:US
Mailing Address - Phone:859-303-6464
Mailing Address - Fax:859-303-6465
Practice Address - Street 1:3221 SUMMIT SQUARE PL STE 200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2655
Practice Address - Country:US
Practice Address - Phone:859-303-6464
Practice Address - Fax:859-303-6465
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1485DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1485DTOtherSTATE LICENSE
KY1485DTOtherSTATE LICENSE
KY0778801Medicare ID - Type Unspecified