Provider Demographics
NPI:1326558800
Name:RANDI S MCMICHAEL OD PLLC
Entity Type:Organization
Organization Name:RANDI S MCMICHAEL OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:SARA
Authorized Official - Last Name:MCMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-641-7482
Mailing Address - Street 1:10422 28TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-1212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15600 NE 8TH ST # F13A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-3927
Practice Address - Country:US
Practice Address - Phone:425-641-7482
Practice Address - Fax:425-505-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60686871261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1902263742Other1902263742