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Individual
RANDELL R RAY
Active
Individual
RANDELL R RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2873TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014FG
BLUE CROSS BLUE SHIELD OF TEXAS
TX
01
—
0A5413
MEDICARE PTAN
TX
05
—
281337001
—
TX
05
—
281337003
—
TX
01
—
8F23186
MEDICARE PTAN
TX
Enumeration date
06/03/2006
Last updated
03/22/2017
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