Provider Demographics
NPI:1982754057
Name:HOLYFIELD, RANDALL L SR (BC-HIS ACA)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:L
Last Name:HOLYFIELD
Suffix:SR
Gender:M
Credentials:BC-HIS ACA
Other - Prefix:MR
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:HOLYFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BC-HIS ACA
Mailing Address - Street 1:1135 N LINCOLN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-4877
Mailing Address - Country:US
Mailing Address - Phone:970-292-8023
Mailing Address - Fax:970-292-8459
Practice Address - Street 1:1135 N LINCOLN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-4877
Practice Address - Country:US
Practice Address - Phone:970-292-8023
Practice Address - Fax:970-292-8459
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7090237700000X
AZHAD 5089237700000X
MIBC-HIS 6793237700000X
COHA 223237700000X
TX80372237700000X
MIACA237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter