Antwan Percy Randolph, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

748 Issued in SD

Practice address

2549 Yukon PL
Spearfish, SD 57783-8531

Phone

(605) 549-1212

Fax

(605) 549-1313

NPI assigned

Oct 21, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, SD2 enrollments

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 2

Specialty

Optometry

Education

Indiana University - School of Optometry, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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 and National Provider Directory roles.

• Atlas PLLC

  • Optometrist
  • Rapid City, SD
  • NPI 1760951107
  Medicare reassignment Authorized official
• Vision Health PLLC

  dba Vision Health

  • Optometrist
  • Tumwater, WA
  • NPI 1184781353
  Medicare reassignment NPD
• Atlas LLC

  dba Atlas PLLC

  • Optometrist
  • Spearfish, SD
  • NPI 1821769027
  NPD

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

{
    "created_epoch": "1256083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1568798841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 TIMBERLINE RD",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577839642",
            "telephone_number": "605-642-2533",
            "fax_number": "605-642-2559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2549 YUKON PL",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577838531",
            "telephone_number": "605-549-1212",
            "fax_number": "605-549-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "ANTWAN",
        "middle_name": "PERCY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-10-21",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2010002259",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "2911",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "SD",
            "license": "748",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "SD",
            "license": "748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sierra Price
• Queen City Medical Center
• Queen City Regional Medical Clinic
• Brandie Lynn Rainboth, DPT
• Fey De Los Angeles Ramirez, BS
• Rocky Rardon
• Danielle Raysor
• Regional Health Network Inc (Regional Health Spearfish Hosptial)
• Regional Health Network Inc (Home Medical Equipment)
• Regional Health Network Inc (Queen City Regional Medical Clinic)

• Optometrist in Spearfish, SD
• Providers in Spearfish, SD by specialty
• Optometrist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; 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.