Provider Demographics
NPI:1144220104
Name:WHITFORD, RANDOLPH P (MD)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:P
Last Name:WHITFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EYES OVER TEXAS EYE
Other - Middle Name:
Other - Last Name:CARE, P.A.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:21318 PROVINCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7580
Mailing Address - Country:US
Mailing Address - Phone:281-398-0747
Mailing Address - Fax:281-398-9825
Practice Address - Street 1:21318 PROVINCIAL BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7580
Practice Address - Country:US
Practice Address - Phone:281-398-0747
Practice Address - Fax:281-398-9825
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4680207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131630907Medicaid
TX131630907Medicaid
TXB27539Medicare UPIN
TX00F84GMedicare ID - Type Unspecified