1144007071 NPI number — RANDI L DAY OD LLC

Table of content: (NPI 1144007071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144007071 NPI number — RANDI L DAY OD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDI L DAY OD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144007071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 RIVERVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73601-1805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-445-1066
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
818 FRISCO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73601-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-440-0077
Provider Business Practice Location Address Fax Number:
580-200-1096
Provider Enumeration Date:
09/13/2023

Additional Information

Authorized Official

Authorized Official Last Name:
DAY
Authorized Official First Name:
RANDI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
580-445-1066

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200212850A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com