Provider Demographics
NPI:1669533238
Name:ASH, RANDY W (OD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:W
Last Name:ASH
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:765 E COLLEGE DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5547
Mailing Address - Country:US
Mailing Address - Phone:970-385-4599
Mailing Address - Fax:970-385-5254
Practice Address - Street 1:765 E COLLEGE DR
Practice Address - Street 2:SUITE #1
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5547
Practice Address - Country:US
Practice Address - Phone:970-385-4599
Practice Address - Fax:970-385-5254
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2017-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO1424152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08014243Medicaid
COU05333Medicare UPIN
CO08014243Medicaid