Provider Demographics
NPI:1033170733
Name:RUSSO, GIUSEPPINA M (OD)
Entity Type:Individual
Prefix:DR
First Name:GIUSEPPINA
Middle Name:M
Last Name:RUSSO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:2799 RT 112
Practice Address - Street 2:DAVIS VISION AT KING KUHLEN SHOPPING CENTER
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763
Practice Address - Country:US
Practice Address - Phone:631-289-3937
Practice Address - Fax:631-207-0913
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0063921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U87709Medicare UPIN
NYC178A1Medicare ID - Type Unspecified