Provider Demographics
NPI:1962407817
Name:U'REN, RANDY SCOTT (OD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:SCOTT
Last Name:U'REN
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 1:200 S. CEDAR ST.
Mailing Address - Street 2:P.O. BOX 460
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-0460
Mailing Address - Country:US
Mailing Address - Phone:231-271-4544
Mailing Address - Fax:
Practice Address - Street 1:200 S. CEDAR ST.
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-0460
Practice Address - Country:US
Practice Address - Phone:231-271-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004209152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U98693Medicare UPIN
MIP14160002Medicare ID - Type Unspecified