Provider Demographics
NPI:1659462257
Name:WINDER, RANDALL K (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:K
Last Name:WINDER
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:PO BOX 3043
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84771-3043
Mailing Address - Country:US
Mailing Address - Phone:435-256-0012
Mailing Address - Fax:435-256-0013
Practice Address - Street 1:835 N 3050 E
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-9041
Practice Address - Country:US
Practice Address - Phone:435-256-0012
Practice Address - Fax:435-256-0013
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT364760-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT364760-9934OtherUTAH LICENSE NUMBER
UT364760-9934OtherUTAH LICENSE NUMBER