Provider Demographics
NPI:1073831822
Name:RANDY WATSKY ODPC
Entity Type:Organization
Organization Name:RANDY WATSKY ODPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:GREGG
Authorized Official - Last Name:WATSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-220-4499
Mailing Address - Street 1:8709 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2923
Mailing Address - Country:US
Mailing Address - Phone:810-220-4499
Mailing Address - Fax:
Practice Address - Street 1:8709 W GRAND RIVER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2923
Practice Address - Country:US
Practice Address - Phone:810-220-4499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty