Individual
DR. RICHARD JON RUSSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
16 EAST GRANBY RD, GRANBY, CT 06035-2201
(860) 653-3008
(860) 653-0359
Mailing address
PO BOX 359, GRANBY, CT 06035-2201
(860) 653-3008
(860) 653-0359
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
787
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004024410
—
CT
01
—
410022496
RAILROAD MEDICARE
—
Enumeration date
11/20/2006
Last updated
07/08/2007
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