Individual
MR. RANDY W. GODWIN I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DISPENSING OPTICIAN
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1508
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47-5024935
—
NC
Enumeration date
11/23/2015
Last updated
11/23/2015
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