Russell, David L.

Russell, David L. is an sole proprietor health care provider with primary practice located at 1218 North 79Th Street , Kansas City KS 66112-3308. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Russell, David L. can be contacted via phone (913) 788-3234.

Contact Information

Primary practice address
1218 North 79Th Street Kansas City KS 66112-3308
Phone: (913) 788-3234
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1264-2 Kansas
Eye and Vision Services Providers / Optometrist 152W00000X 1264-3 Kansas

Profile Details

NPI number 1578564522
LBN Legal business name Russell, David L.
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 2nd, 2005
Last updated Nov 5th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578564522 NPPES
Kansas MEDICAID 100218380A

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