Provider Demographics
NPI:1093847550
Name:RUSSO OPTICIANS, INC.
Entity Type:Organization
Organization Name:RUSSO OPTICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUDI
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED OPTICIAN
Authorized Official - Phone:413-734-5502
Mailing Address - Street 1:1025 WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3876
Mailing Address - Country:US
Mailing Address - Phone:413-734-5502
Mailing Address - Fax:413-734-4657
Practice Address - Street 1:1025 WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3876
Practice Address - Country:US
Practice Address - Phone:413-734-5502
Practice Address - Fax:413-734-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2058332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0412060001Medicare NSC