Individual
DAVID L. RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1218 NORTH 79TH STREET, KANSAS CITY, KS 66112-3308
(913) 788-3234
Mailing address
1218 NORTH 79TH STREET, KANSAS CITY, KS 66112-3308
(913) 788-3234
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1264-2
KS
152W00000X
Optometrist
Primary
1264-3
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100218380A
—
KS
Enumeration date
08/02/2005
Last updated
11/05/2011
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