Individual
MR. RANDY L DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
1025 WH SMITH BLVD, SUITE 108, GREENVILLE, NC 27834-5052
(252) 215-2215
(252) 215-2216
Mailing address
1025 WH SMITH BLVD, SUITE 108, GREENVILLE, NC 27834-5052
(252) 215-2215
(252) 215-2216
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO02290
DE
224P00000X
Prosthetist
Primary
CPO02290
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009190511
—
VA
01
—
384410
BCBS
VA
Enumeration date
04/23/2010
Last updated
06/10/2013
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