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Contact Information

DAVID R RUSSELL OD
720 6TH ST
EVANSTON, WY82930
 Phone: 307-789-1500
 Fax: 307-789-0077
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for DAVID R RUSSELL OD

NPI Number 1700076643
LBN Legal business name DAVID R RUSSELL OD
Authorized official DAVID RUSSELL - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 07/26/2007
Last updated 08/02/2018 - About 8 years ago
Identifiers
WY License # 293T
WY Medicaid 121954500
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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