Active NPI
Randolph E Black, M.D.
- Ophthalmology Physician
- Albuquerque, NM
National Provider Identifier
1497736870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 83165
- Practice address
- 7110 Wyoming Blvd NE
Albuquerque, NM 87109-4867 - Phone
- (505) 346-0500
- Fax
- (505) 346-0164
- NPI assigned
- Nov 10, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 83165 | NM | Primary |
Addresses
Primary practice location
7110 Wyoming Blvd NE
Albuquerque, NM 87109-4867
Mailing address
7110 Wyoming Blvd NE
Albuquerque, NM 87109-4867
Phone (505) 346-0500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33357 | Medicaid | NM |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 83165 | NM | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260748800000",
"number": "1497736870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7110 WYOMING BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871094867",
"telephone_number": "505-346-0500",
"fax_number": "505-346-0164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7110 WYOMING BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871094867",
"telephone_number": "505-346-0500",
"fax_number": "505-346-0164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "RANDOLPH",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-10",
"last_updated": "2009-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NM",
"license": "83165",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33357",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.