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
Phone: (307) 789-1500
Fax: (307) 789-0077
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1992898894 | NPPES |
| Wyoming | MEDICAID | 1219545 00 |
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