Provider Demographics
NPI:1265194443
Name:JOHN RANDALL TRAWNIK
Entity type:Organization
Organization Name:JOHN RANDALL TRAWNIK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:TRAWNIK
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:214-739-5355
Mailing Address - Street 1:4600 GREENVILLE AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5037
Mailing Address - Country:US
Mailing Address - Phone:214-739-5355
Mailing Address - Fax:
Practice Address - Street 1:4600 GREENVILLE AVE STE 240
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5037
Practice Address - Country:US
Practice Address - Phone:214-739-5355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty