Provider Demographics
NPI:1962603738
Name:LERNER, RANDY EDWARD (AUD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:EDWARD
Last Name:LERNER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 BOONE RD SE
Mailing Address - Street 2:STE 120
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9675
Mailing Address - Country:US
Mailing Address - Phone:971-701-6322
Mailing Address - Fax:971-915-2689
Practice Address - Street 1:2700 SE STRATUS AVE UNIT 402
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6258
Practice Address - Country:US
Practice Address - Phone:503-434-1110
Practice Address - Fax:503-434-1119
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
OR23563231H00000X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR176871Medicare PIN