Provider Demographics
NPI:1982932646
Name:WIK, RANDA JEAN
Entity Type:Individual
Prefix:
First Name:RANDA
Middle Name:JEAN
Last Name:WIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16888 RIVER OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-7629
Mailing Address - Country:US
Mailing Address - Phone:218-739-2979
Mailing Address - Fax:
Practice Address - Street 1:615 S MILL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2756
Practice Address - Country:US
Practice Address - Phone:218-998-2020
Practice Address - Fax:218-998-2098
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN166965156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician