Basic Information
| Provider Information | |||||||||
| NPI: | 1982690566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUGHES | ||||||||
| FirstName: | RANDAL | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 549 | ||||||||
| Address2: | |||||||||
| City: | WABASH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469920549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2605699550 | ||||||||
| FaxNumber: | 2605690760 | ||||||||
| Practice Location | |||||||||
| Address1: | 7747 W JEFFERSON BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604598444 | ||||||||
| FaxNumber: | 2604598443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 08/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 30120 | KY | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 036093071 | IL | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 01039469 | IN | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 000000108303 | 01 | ANTHEM | OTHER | 289993 | 01 | HEALTHLINK | OTHER | 200094570 | 05 | IN | MEDICAID | 5984162 | 01 | AETNA | OTHER | 64301203 | 05 | KY | MEDICAID |