MEDICARE: DR. RANDY SCOTT U'REN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901004209	MI

General Provider Information

NPI Number	:	1962407817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY SCOTT U'REN O.D.

Provider Business Mailing Address
First Line	:	200 S. CEDAR ST.
Second Line	:	P.O. BOX 460
City	:	SUTTONS BAY
State	:	MI
Zip	:	49682-0460
Country	:	US
Telephone Number	:	231-271-4544
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S. CEDAR ST.
Second Line	:
City	:	SUTTONS BAY
State	:	MI
Zip	:	49682-0460
Country	:	US
Telephone Number	:	231-271-4544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	06/09/2011

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