Individual
MR. RANDY J PRESTASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
608 SUMMIT AVE, OCONOMOWOC, WI 53066-3841
(262) 567-6565
(262) 567-8214
Mailing address
608 SUMMIT AVE, OCONOMOWOC, WI 53066-3841
(262) 567-6565
(262) 567-8214
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
WI1780-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38515200
—
WI
Enumeration date
03/15/2007
Last updated
12/28/2012
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