Provider Demographics
NPI:1902998966
Name:FUERST, RANDALL F (OD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:F
Last Name:FUERST
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 1:5959 GREENBACK LN
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-4700
Mailing Address - Country:US
Mailing Address - Phone:916-726-1818
Mailing Address - Fax:916-726-1822
Practice Address - Street 1:5959 GREENBACK LN
Practice Address - Street 2:SUITE 130
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-4700
Practice Address - Country:US
Practice Address - Phone:916-726-1818
Practice Address - Fax:916-726-1822
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7914T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0079141Medicare ID - Type Unspecified
CAT10169Medicare UPIN