Healthcare Provider Details

I. General information

NPI: 1497422588
Provider Name (Legal Business Name): MR. RANDALL STACY CARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 1ST AVE W
SEATTLE WA
98119-4018
US

IV. Provider business mailing address

20127 108TH DR SE
SNOHOMISH WA
98296-8196
US

V. Phone/Fax

Practice location:
  • Phone: 206-325-0645
  • Fax:
Mailing address:
  • Phone: 425-471-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number61065604
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: