Individual
DR. DAVID RAY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
293T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1219545 00
—
WY
Enumeration date
10/02/2006
Last updated
08/02/2018
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