Individual
DR. BROOKS RANDALL ALLDREDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
ATI2539
OR
152W00000X
Optometrist
OD00001864
WA
152W00000X
Optometrist
ODP-100001
ID
152W00000X
Optometrist
OPT-OPT-LIC-2803
MT
152W00000X
Optometrist
Primary
OPT589
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01879341
—
NM
05
—
8082271700
—
ID
Enumeration date
02/13/2007
Last updated
11/12/2020
Update your record
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