Provider Demographics
NPI:1538234026
Name:GO, RANDALL (OD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:GO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2415
Mailing Address - Country:US
Mailing Address - Phone:415-648-2129
Mailing Address - Fax:415-647-2411
Practice Address - Street 1:2458 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2415
Practice Address - Country:US
Practice Address - Phone:415-648-2129
Practice Address - Fax:415-647-2411
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7473T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0074730Medicaid
CASD0074730Medicaid
CACS829AMedicare PIN