Individual
MR. ALFRED MICHAEL RUSSITANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
174 CANAL ST, CANASTOTA, NY 13032-1335
(315) 697-3334
(315) 697-3423
Mailing address
174 CANAL ST, CANASTOTA, NY 13032-1335
(315) 697-3334
(315) 697-3423
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
4846
NY
Other
Enumeration date
09/28/2006
Last updated
03/18/2008
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