Individual
DANA S RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
20 N DEWITT AVE, CLOVIS, CA 93612-0311
(559) 299-2578
(559) 299-1557
Mailing address
20 N DEWITT AVE, CLOVIS, CA 93612-0311
(559) 299-2578
(559) 299-1557
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
SL6061
CA
Other
Enumeration date
09/22/2009
Last updated
09/22/2009
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