Randy Dawayne Eason, O.D.
Individual provider Active NPI Optometrist · Forest, MS
NPI 1417048620 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1417048620
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 481 (MS)
- Practice address
- 516 Airport Rd
Forest, MS 39074-4032 - Phone
- (601) 469-2020
- Fax
- (601) 469-5686
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 481 | MS | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 481 | MS | Yes |
Addresses
Primary practice location
516 Airport Rd
Forest, MS 39074-4032
Mailing address
516 Airport Rd
Forest, MS 39074-4032
Phone (601) 469-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00088059 | Medicaid | MS |
Other providers in Forest, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.