Individual
RUSSELL MARK WOHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
255 MAIN ST, FARMINGDALE, NY 11735-2619
(516) 249-0052
(516) 249-7000
Mailing address
255 MAIN ST, FARMINGDALE, NY 11735-2619
(516) 249-0052
(516) 249-7000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV0043431
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01524496
—
NY
Enumeration date
12/13/2005
Last updated
09/21/2010
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