=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902998966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RANDALL F FUERST O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9221 SIERRA COLLEGE BLVD STE 130
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661-5934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-797-6747
-----------------------------------------------------
Fax | 916-797-6728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9221 SIERRA COLLEGE BLVD STE 130
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661-5934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-797-6747
-----------------------------------------------------
Fax | 916-797-6728
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7914
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7914T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------