Individual
DR. RYAN D RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
610 BRUNSON DR, TUPELO, MS 38801-4947
(662) 844-7211
(662) 844-7574
Mailing address
122 WILLOWBROOK DR, SALTILLO, MS 38866-6895
(662) 869-1779
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
698
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00001062
—
MS
Enumeration date
10/28/2005
Last updated
07/31/2017
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