Individual
RUSSELL FRADKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
999 PROVIDENCE RD, WHITINSVILLE, MA 01588
(508) 234-6681
(508) 234-6507
Mailing address
999 PROVIDENCE RD, WHITINSVILLE, MA 01588
(508) 234-6681
(508) 234-6507
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2699
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0333913
—
MA
01
—
6000000019
HARVARD PILGRIM HEALTHCAR
—
01
—
725524
TUFTS HEALTH PLAN
MA
01
—
W15622
BLUE CROSS OF MASS
MA
01
—
W20190
BLUE CROSS OF MASS
MA
Enumeration date
03/17/2006
Last updated
03/24/2009
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