Individual
DERRICK RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
600 ONTARIO ST, STORM LAKE, IA 50588-1845
(712) 732-3233
(712) 732-1866
Mailing address
600 ONTARIO ST, STORM LAKE, IA 50588-1845
(712) 732-3233
(712) 732-1866
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
087654
IA
Other
Enumeration date
07/05/2016
Last updated
03/27/2018
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