Provider Demographics
NPI:1609851344
Name:ALESSI, RANDALL RALPH (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:RALPH
Last Name:ALESSI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25401 ALICIA PKWY
Mailing Address - Street 2:SUIT E
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25401 ALICIA PKWY
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4958
Practice Address - Country:US
Practice Address - Phone:949-951-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002985152W00000X
CA8651 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2743033Medicaid
CAOP8651Medicare ID - Type Unspecified
CAU51364Medicare UPIN