Randall K Puckett

Primary specialty

OptometristTaxonomy code 152W00000X

License

1190DT Issued in KY

Practice address

225 Hospital Dr BLDG B Ste 160
Winchester, KY 40391

Phone

(859) 744-4429

Fax

(859) 745-7702

NPI assigned

Aug 24, 2005

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Puckett Family Eye Care PLLCGroup PAC ID 3274637624, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Puckett Family Eye Care, PLLC

  • Optometrist
  • Winchester, KY
  • NPI 1083775878
  Medicare reassignment Care Compare group NPD Authorized official
• Eyecare Center Optometrist PSC

  • Optometrist
  • Irvine, KY
  • NPI 1700072253
  NPD (past)
• Eyecare Center Optometrist PSC

  • Optometrist
  • Richmond, KY
  • NPI 1851384960
  NPD (past)

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1326031527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 HOSPITAL DR STE 160",
            "city": "WINCHESTER",
            "state": "KY",
            "postal_code": "40391",
            "telephone_number": "859-744-4429",
            "fax_number": "859-745-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 HOSPITAL DR BLDG B STE 160",
            "city": "WINCHESTER",
            "state": "KY",
            "postal_code": "40391",
            "telephone_number": "859-744-4429",
            "fax_number": "859-745-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "RANDALL",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2023-03-07",
        "certification_date": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1190DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77011906",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tena Hoffman Powe, DMD
• Mary Alice Prater, PT
• Premier Eye Care, PLLC
• Regina Ann Prewitt, APRN
• Puckett Family Eye Care, PLLC
• Jacob Marshall Qualls, LCADC
• Stacey Rapier, LMT
• Sheena Barshea Ratliff
• Shelby Ray
• RB Speciality Group LLC (RB Specialty)

• Optometrist in Winchester, KY
• Providers in Winchester, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.