Individual
DR. KEVIN JOSEPH RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2048 E. BASELINE RD., SUITE C6, MESA, AZ 85204
(480) 245-8929
(480) 507-0836
Mailing address
23490 S. 201ST ST., QUEEN CREEK, AZ 85142
(480) 245-8929
(480) 507-0836
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
779
AZ
Other
Enumeration date
11/06/2007
Last updated
04/24/2018
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