Provider Demographics
NPI:1588977656
Name:WATSON, RANDEE MILLER (MD)
Entity type:Individual
Prefix:
First Name:RANDEE
Middle Name:MILLER
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29201 TELEGRAPH RD STE 606
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1300
Mailing Address - Country:US
Mailing Address - Phone:248-356-8610
Mailing Address - Fax:
Practice Address - Street 1:29201 TELEGRAPH RD STE 606
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1300
Practice Address - Country:US
Practice Address - Phone:248-356-8610
Practice Address - Fax:248-356-6473
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097016207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist