Individual
DR. PHILLIP RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
16006 CRAIN HWY, BRANDYWINE, MD 20613-8081
(301) 372-3213
(301) 372-3214
Mailing address
15004 RESERVE RD, ACCOKEEK, MD 20607-9403
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA1971
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010045711
—
MD
Enumeration date
07/27/2006
Last updated
10/25/2011
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