Russo, Diane M
Russo, Diane M is an sole proprietor health care provider with primary practice located at 637 Washington St , Dorchester MA 02124-3510. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Russo, Diane M can be contacted via phone (617) 825-9660.Contact Information
Primary practice address
637 Washington St
Dorchester MA 02124-3510
Phone: (617) 825-9660
Fax: (617) 288-7898
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 002810 | Connecticut |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 4926 | Massachusetts |
Profile Details
| NPI number | 1174839146 |
|---|---|
| LBN Legal business name | Russo, Diane M |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 27th, 2010 |
| Last updated | Nov 27th, 2023 - about 3 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 | 1174839146 | NPPES |
| Massachusetts | MEDICAID | 110101577A |
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