Individual
JENNIFER RANDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
200 MIFFLIN AVE, SCRANTON, PA 18503
(570) 342-3145
(570) 344-1309
Mailing address
200 MIFFLIN AVE, SCRANTON, PA 18503
(570) 342-3145
(570) 344-1309
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001721
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101631867
—
PA
Enumeration date
09/05/2006
Last updated
01/11/2010
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