Provider Demographics
NPI:1184925737
Name:LUKE A. RANDALL PLLC
Entity type:Organization
Organization Name:LUKE A. RANDALL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-473-0172
Mailing Address - Street 1:112 W CLAIRE ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7521
Mailing Address - Country:US
Mailing Address - Phone:208-473-0172
Mailing Address - Fax:
Practice Address - Street 1:7319 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6051
Practice Address - Country:US
Practice Address - Phone:208-853-4786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100164152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty