Russell, Ryan D
Russell, Ryan D is an individual health care provider with primary practice located at 610 Brunson Dr , Tupelo MS 38801-4947. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Russell, Ryan D can be contacted via phone (662) 844-7211.Contact Information
Primary practice address
610 Brunson Dr
Tupelo MS 38801-4947
Phone: (662) 844-7211
Fax: (662) 844-7574
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 698 | Mississippi |
Profile Details
| NPI number | 1831180900 |
|---|---|
| LBN Legal business name | Russell, Ryan D |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 28th, 2005 |
| Last updated | Jul 31st, 2017 - about 7 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 | 1831180900 | NPPES |
| Mississippi | MEDICAID | 00001062 |
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