Russell, David Ray

Russell, David Ray is an individual health care provider with primary practice located at 720 6Th St , Evanston WY 82930. 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 Ray can be contacted via phone (307) 789-1500.

Contact Information

Primary practice address
720 6Th St Evanston WY 82930
Fax: (307) 789-0077
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 293T Wyoming

Profile Details

NPI number 1992898894
LBN Legal business name Russell, David Ray
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 2nd, 2006
Last updated Aug 2nd, 2018 - about 8 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 1992898894 NPPES
Wyoming MEDICAID 1219545 00

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