Russell, Sam O
Russell, Sam O is an sole proprietor health care provider with primary practice located at 240 W Evans St , Florence SC 29501-3428. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Russell, Sam O can be contacted via phone (843) 662-3278.Contact Information
Primary practice address
240 W Evans St
Florence SC 29501-3428
Phone: (843) 662-3278
Fax: (843) 667-6090
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 601 | South Carolina |
Profile Details
| NPI number | 1063479111 |
|---|---|
| LBN Legal business name | Russell, Sam O |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 1st, 2006 |
| Last updated | Apr 24th, 2008 - about 16 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 | 1063479111 | NPPES |
| South Carolina | MEDICAID | D06018 |
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