Individual
DR. RUSSELL L DOERKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1324
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049837
BLUE CROSS/BLUE SHIELD
KS
01
—
3712
PREFERRED HEALTH SYSTEM
KS
Enumeration date
09/20/2006
Last updated
06/10/2015
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