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Organization

DAVID R RUSSELL OD

Active
Other names
Vision Source, Accurate Eye Care
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID R RUSSELL OD (PRESIDENT)
(307) 789-1500
Entity
Organization

Contact information

Practice address
720 6TH ST, EVANSTON, WY 82930
(307) 789-1500
(307) 789-0077
Mailing address
916 MAIN ST, EVANSTON, WY 82930-3441
(307) 789-1500
(307) 789-0077

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
293T
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
121954500
WY
Enumeration date
07/26/2007
Last updated
08/02/2018
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