Individual
JOHN RANDALL SAMPLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
215 LILLY RD NE, OLYMPIA, WA 98506-5030
(360) 456-4800
(360) 456-4800
Mailing address
215 LILLY RD NE, OLYMPIA, WA 98506-5030
(360) 456-4800
(360) 456-4812
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
MD 13791
OR
207W00000X
Ophthalmology Physician
Primary
MD00030114
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180040576
RAILROAD MEDICARE
—
05
—
2044175
—
WA
05
—
289959
—
OR
01
—
360398
L&I
WA
Enumeration date
05/16/2006
Last updated
03/17/2018
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