Provider Demographics
NPI:1538173489
Name:RANDOLPH EYE, PC
Entity type:Organization
Organization Name:RANDOLPH EYE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-986-7400
Mailing Address - Street 1:27 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4505
Mailing Address - Country:US
Mailing Address - Phone:781-986-7400
Mailing Address - Fax:
Practice Address - Street 1:27 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4505
Practice Address - Country:US
Practice Address - Phone:781-986-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA708853AOtherTUFTS
1152531OtherUHC GROUP
MAW20030OtherBCBS GROUP
MA9726659Medicaid
0339230001Medicare NSC
MA708853AOtherTUFTS