Individual
DR. JOHN WILFRED RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD, MPH
Contact information
Practice address
2043 COLLEGE WAY, PACIFIC UNIVERSITY COLLEGE OF OPTOMETRY, FOREST GROVE, OR 97116-1756
(503) 352-2020
(503) 352-2929
Mailing address
30 EILER LN, ZILLAH, WA 98953-9731
(509) 865-1877
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1012
OK
152W00000X
Optometrist
Primary
1610AT
OR
Other
Enumeration date
11/02/2005
Last updated
07/08/2007
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