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NPI Profile for RUSSELL J AVERY SR in ENDICOTT, NY.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Optician |
156FX1800X | 96[5] | Optician |
| NPI # | 1467598334 |
|
| Status | Active | |
| Credentials | LICENSED OPTICIAN | |
| Entity | Individual | |
| Enumeration date | 01/29/2007 | |
| Last updated | 07/09/2007 - About 19 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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RUSSELL J AVERY SR
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RUSSELL J AVERY SR, LICENSED OPTICIAN