Provider Demographics
NPI:1700093366
Name:RADFORD, IAN THOMAS (LDO,CPO)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:THOMAS
Last Name:RADFORD
Suffix:
Gender:M
Credentials:LDO,CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0811
Mailing Address - Country:US
Mailing Address - Phone:910-382-2020
Mailing Address - Fax:910-350-1715
Practice Address - Street 1:3500 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0811
Practice Address - Country:US
Practice Address - Phone:910-382-2020
Practice Address - Fax:910-350-1715
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1822156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1822OtherNC OPTICIAN LISCENSE