Provider Demographics
NPI:1104853522
Name:LOUDENSLAGER, RANDALL S (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:S
Last Name:LOUDENSLAGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:36254 WENDELL ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4415
Mailing Address - Country:US
Mailing Address - Phone:440-661-8169
Mailing Address - Fax:
Practice Address - Street 1:5700 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4152
Practice Address - Country:US
Practice Address - Phone:440-988-4040
Practice Address - Fax:440-988-4041
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ923152W00000X
OH4796152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist