Individual
DR. RANDALL M WEISHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
220 S MAIN ST, ROCHESTER, MI 48307-2029
(248) 651-7986
Mailing address
220 S MAIN ST, ROCHESTER, MI 48307-2029
(248) 651-7986
(248) 651-3452
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004032
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F37720
MEDICARE PTAN
—
05
—
1518945104
—
MI
05
—
4148400
—
MI
05
—
4148410
—
MI
05
—
4685330
—
MI
01
—
RW004032
BLUE CROSS
MI
Enumeration date
01/04/2006
Last updated
05/16/2016
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