Provider Demographics
NPI:1508903766
Name:PAYE, RANDALL J (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:J
Last Name:PAYE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1515 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-2272
Mailing Address - Country:US
Mailing Address - Phone:920-499-2147
Mailing Address - Fax:920-499-0574
Practice Address - Street 1:1515 6TH ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-2272
Practice Address - Country:US
Practice Address - Phone:920-499-2147
Practice Address - Fax:920-499-0574
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1546-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1546-035OtherSTATE LICENSE #
WI1546-035OtherSTATE LICENSE #
WIMP0094627OtherDEA#