Individual
DR. DAVID RAY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
720 6TH ST, EVANSTON, WY 82930
(307) 789-1500
(307) 789-0077
Mailing address
720 6TH ST, EVANSTON, WY 82930-3702
(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
—
1219545 00
—
WY
Enumeration date
10/02/2006
Last updated
08/02/2018
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