Individual
PETER ANTHONY RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2160 S 1ST AVE, (17W740 22ND STEERT, OAKBROOK TERRACE, IL. 60181), MAYWOOD, IL 60153
(630) 627-7399
(630) 627-7079
Mailing address
2160 S 1ST AVE, (17W740 22ND STEERT, OAKBROOK TERRACE, IL. 60181), MAYWOOD, IL 60153
(630) 627-7399
(630) 627-7079
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
46008021
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46008021
—
IL
Enumeration date
02/15/2006
Last updated
03/04/2010
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