Individual
PENNY LEE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO ABO NCLE
Contact information
Practice address
17105 SAN CARLOS BLVD, FORT MYERS BEACH, FL 33931-5305
(239) 340-7071
(239) 466-9015
Mailing address
15186 IONA LAKES DR, FORT MYERS, FL 33908-1871
(239) 340-7071
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO7367
FL
Other
Enumeration date
05/09/2023
Last updated
05/09/2023
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