Individual
DR. RICHARD NICHOLS RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2240 NASH ST N, WILSON, NC 27896-1729
(252) 237-4179
(252) 237-4170
Mailing address
2240 NASH ST N, WILSON, NC 27896-1729
(252) 237-4179
(252) 237-4170
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1308
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09753
BLUE CROSS BLUE SHIELD
NC
05
—
7909753
—
NC
Enumeration date
12/22/2005
Last updated
02/27/2015
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