Individual
DR. SAM O RUSSELL III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
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
152W00000X
Optometrist
Primary
601
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D06018
—
SC
Enumeration date
05/01/2006
Last updated
04/24/2008
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