Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DPO0000000487 | TN |
NPI | 1093011033 |
---|---|
Provider Name | Mr. Randal L Cheek |
First Address | Columbia, TN 38401-3989 |
Second Address | Columbia, TN 38401-3989 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2011 |
Last Update Date | 09/02/2011 |