Provider Demographics
NPI:1013359504
Name:SAUER, RANDALL SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:SCOTT
Last Name:SAUER
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 1:1711 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4200
Mailing Address - Country:US
Mailing Address - Phone:405-372-1715
Mailing Address - Fax:405-372-3350
Practice Address - Street 1:1711 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4200
Practice Address - Country:US
Practice Address - Phone:405-372-1715
Practice Address - Fax:405-372-3350
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist