Individual
SUSAN MELISSA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
420 FACTORY OUTLET DR, HANSON, KY 42413-9513
(270) 821-7177
(270) 322-8192
Mailing address
420 FACTORY OUTLET DR, HANSON, KY 42413-9513
(270) 821-7177
(270) 322-8192
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
110443
KY
Other
Enumeration date
06/09/2022
Last updated
06/09/2022
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