Provider Demographics
NPI:1992963037
Name:MISKE, RANDALL J
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:J
Last Name:MISKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:PA
Mailing Address - Zip Code:17976-2337
Mailing Address - Country:US
Mailing Address - Phone:570-462-2254
Mailing Address - Fax:
Practice Address - Street 1:117 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-2337
Practice Address - Country:US
Practice Address - Phone:570-462-2254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician