NPIMap

Individual provider Active NPI

Randy L Light, B.C.O., B.A.D.O.

  • Ocularist
  • Peoria, IL
National Provider Identifier
1124060074
Registry record updated Jul 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OcularistTaxonomy code 156FX1700X
License
203.000116 Issued in IL
Practice address
1318 W Candletree Dr
Suite 3
Peoria, IL 61614-8508
Phone
(309) 676-3663
Fax
(309) 676-0359
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ocularist 156FX1700X 203.000116 IL Primary

Addresses

Primary practice location

1318 W Candletree Dr
Suite 3
Peoria, IL 61614-8508

Mailing address

1318 W Candletree Dr
Suite 3
Peoria, IL 61614-8508
Phone (309) 676-3663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
203.000116ILMDOcularist

Practice roles

OrganizationSpecialtyStatusNew patients
Lights Prosthetic Eyes Inc Ocularist Past Accepting new patients
Lights Prosthetic Eyes Inc Ocularist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246579200000",
    "number": "1124060074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1318 W CANDLETREE DR",
            "address_2": "SUITE 3",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148508",
            "telephone_number": "309-676-3663",
            "fax_number": "309-676-0359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1318 W CANDLETREE DR",
            "address_2": "SUITE 3",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148508",
            "telephone_number": "309-676-3663",
            "fax_number": "309-676-0359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIGHT",
        "first_name": "RANDY",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "B.C.O., B.A.D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2009-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1700X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Ocularist",
            "state": "IL",
            "license": "203.000116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.