Doctor Name: | MR. ALFRED MICHAEL RUSSITANO |
NPI Number: | 1053403972 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | OPTICIAN |
License Number: | 4846 |
Business Practice Address: | 174 Canal St Canastota, NY - 130321335 |
Business Phone Number: | 3156973334 |
Business Fax Number: | 3156973423 |
Mailing Address: | 174 Canal St, CANASTOTA |
State: | NY |
Postal Code: | 130321335 |
Phone Number: | 3156973334 |
Fax Number: | 3156973423 |
NPI Enumeration Date: | 09/28/2006 |
NPI Last Update Date: | 03/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 4846 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |