Provider Demographics
NPI:1174590285
Name:HOUDEK, RANDY GERARD (OD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:GERARD
Last Name:HOUDEK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:38979 CHERRY HILL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-3250
Mailing Address - Country:US
Mailing Address - Phone:734-326-2160
Mailing Address - Fax:734-326-9678
Practice Address - Street 1:38979 CHERRY HILL RD
Practice Address - Street 2:SUITE B
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-3250
Practice Address - Country:US
Practice Address - Phone:734-326-2160
Practice Address - Fax:734-326-9678
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI49001002809152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU40432Medicare UPIN
MI0862660001Medicare NSC
MIN87870001Medicare PIN