Organization Name: | RICHARD R. RUSSELL, O.D. |
NPI Number: | 1679714158 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD RAWLS RUSSELL (OPTOMETRIST) |
Mailing Address: | 210 S Odom St Bastrop |
State: | LA US |
Postal Code: | 712204631 |
Phone Number: | 3182812200 |
Fax Number: | 3182817359 |
NPI Enumeration Date: | 03/13/2009 |
NPI Last Update Date: | 03/13/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 872-292T |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |