Individual
RENEE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2121 W DIVISION ST, CHICAGO, IL 60622-2948
(847) 814-5514
Mailing address
2121 W DIVISION ST, CHICAGO, IL 60622-2948
(847) 814-5514
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
04/30/2008
Last updated
04/30/2008
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