Individual
DR. GREGORY CLINTON RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT1813
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3941713
—
TN
01
—
4076931
BLUE CROSS BLUE SHIELD OF
TN
Enumeration date
07/12/2006
Last updated
07/09/2007
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