Individual
DR. JONATHAN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
12100 SE STEVENS CT, SUITE 106, CLACKAMAS, OR 97086-4707
(503) 353-7300
Mailing address
4435 SE 43RD AVE, PORTLAND, OR 97206-4003
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2838T
OR
Other
Enumeration date
05/11/2007
Last updated
08/19/2015
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