Provider Demographics
NPI:1578994448
Name:RANDALL, DONALD DOUGLAS I
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:DOUGLAS
Last Name:RANDALL
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DONALD
Other - Middle Name:DOUGLAS
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HIS
Mailing Address - Street 1:1400 SWEETHOME ROAD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:AMHERST
Mailing Address - State:BUFFALO
Mailing Address - Zip Code:14228
Mailing Address - Country:UM
Mailing Address - Phone:716-639-3737
Mailing Address - Fax:716-639-3738
Practice Address - Street 1:1400 SWEET HOME RD
Practice Address - Street 2:SUITE 9
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2777
Practice Address - Country:US
Practice Address - Phone:716-639-3737
Practice Address - Fax:716-639-3738
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist