Provider Demographics
NPI:1922237197
Name:RANDALL, JOSHUA DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DAVID
Last Name:RANDALL
Suffix:
Gender:M
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:7203 W DESCHUTES AVE
Mailing Address - Street 2:STE B
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7777
Mailing Address - Country:US
Mailing Address - Phone:509-416-0403
Mailing Address - Fax:509-416-0435
Practice Address - Street 1:7203 W DESCHUTES AVE
Practice Address - Street 2:STE B
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7777
Practice Address - Country:US
Practice Address - Phone:509-416-0403
Practice Address - Fax:509-416-0435
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA60136353152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist