Russell, Mandy R
Russell, Mandy R is an individual health care provider with primary practice located at 650 Linden St Suite 5, Big Rapids MI 49307-1879. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Russell, Mandy R can be contacted via phone (231) 796-0010.Contact Information
Primary practice address
650 Linden St Suite 5
Big Rapids MI 49307-1879
Phone: (231) 796-0010
Fax: (231) 796-2496
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 4901004360 | Michigan |
Profile Details
| NPI number | 1316084965 |
|---|---|
| LBN Legal business name | Russell, Mandy R |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 31st, 2007 |
| Last updated | May 13th, 2011 - about 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316084965 | NPPES |
| Michigan | Other | 0E40038 | BCBSM |
| Michigan | Other | CG0293 | BCBSM |
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