Provider Demographics
NPI:1699810952
Name:WOOLF, RANDY DEVOE (OPTOMETRIST (OD))
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:DEVOE
Last Name:WOOLF
Suffix:
Gender:M
Credentials:OPTOMETRIST (OD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 N ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2004
Mailing Address - Country:US
Mailing Address - Phone:509-921-1508
Mailing Address - Fax:
Practice Address - Street 1:JC PENNEY OPTICAL,
Practice Address - Street 2:4730 N. DIVISION ST
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207
Practice Address - Country:US
Practice Address - Phone:509-483-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2006TX152W00000X
ID863OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5690WOOtherASURIS INSURANCE
WA919268OtherEYEMED INSURANCE NUMBER
WA919268OtherEYEMED INSURANCE NUMBER