Provider Demographics
NPI:1710478532
Name:RANDICH, TAYLOR WHITLEY (OD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:WHITLEY
Last Name:RANDICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1910 JAKE ALEXANDER BLVD W STE 101
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1163
Mailing Address - Country:US
Mailing Address - Phone:704-633-2581
Mailing Address - Fax:
Practice Address - Street 1:19070 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2477
Practice Address - Country:US
Practice Address - Phone:813-632-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2766152W00000X
FLOPC5602152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist