Provider Demographics
NPI:1568563740
Name:STEELE, HARRY RANDY JR (OD)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:RANDY
Last Name:STEELE
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:333 BEACON HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-6178
Mailing Address - Country:US
Mailing Address - Phone:606-784-3288
Mailing Address - Fax:606-784-3296
Practice Address - Street 1:333 BEACON HILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-6178
Practice Address - Country:US
Practice Address - Phone:606-784-3288
Practice Address - Fax:606-784-3296
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY610719599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010270Medicaid
KY0330006Medicare PIN
KY0968700002Medicare NSC