Individual
DR. ANTWAN PERCY RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2549 YUKON PL, SPEARFISH, SD 57783-8531
(605) 549-1212
(605) 549-1313
Mailing address
149 TIMBERLINE RD, SPEARFISH, SD 57783-9642
(605) 642-2533
(605) 642-2559
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2010002259
MO
152W00000X
Optometrist
2911
TN
152W00000X
Optometrist
Primary
748
SD
152WV0400X
Vision Therapy Optometrist
748
SD
Other
Enumeration date
10/21/2009
Last updated
09/15/2021
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