Provider Demographics
NPI:1760654735
Name:SAINT JOHN, RANDALL LEE (OD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:LEE
Last Name:SAINT JOHN
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 1:24 VIA CALANDRIA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4576
Mailing Address - Country:US
Mailing Address - Phone:949-498-1961
Mailing Address - Fax:949-388-1893
Practice Address - Street 1:30212 TOMAS
Practice Address - Street 2:SUITE 170
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2172
Practice Address - Country:US
Practice Address - Phone:949-589-0900
Practice Address - Fax:949-589-0767
Is Sole Proprietor?:No
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6107 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist