Organization
RUSSIN EYE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMON R RUSSIN DO (OWNER)
(610) 617-4177
Entity
Organization
Contact information
Practice address
301 CITY AVENUE, SUITE 335, BALA CYNWOOD, PA 19004
(610) 617-4177
(610) 617-4170
Mailing address
301 CITY AVENUE, SUITE 335, BALA CYNWOOD, PA 19004
(610) 617-4177
(610) 617-4170
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
OS009908L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001697374
—
PA
Enumeration date
05/12/2008
Last updated
10/01/2008
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