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Organization
RUSSELL EYECARE
Active
Organization
RUSSELL EYECARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL O RUSSELL III OD (PROVIDER)
(843) 662-3278
Entity
Organization
Contact information
Practice address
240 W EVANS ST, FLORENCE, SC 29501-3428
(843) 662-3278
(843) 667-6090
Mailing address
240 W EVANS ST, FLORENCE, SC 29501-3428
(843) 662-3278
(843) 667-6090
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
601
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D06018
—
SC
Enumeration date
01/15/2008
Last updated
07/22/2011
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