Provider Demographics
NPI:1306856091
Name:DELLO RUSSO, JAMES ERIC (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ERIC
Last Name:DELLO RUSSO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORTH WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621
Mailing Address - Country:US
Mailing Address - Phone:201-384-7333
Mailing Address - Fax:201-385-3881
Practice Address - Street 1:1 NORTH WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621
Practice Address - Country:US
Practice Address - Phone:201-384-7333
Practice Address - Fax:201-385-3881
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00121200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2K5292OtherHEALTHNET
NJ3229881OtherAETNA HMO
NJNJ1300OtherEYE MED VISION
NJ12056OtherSPECTERA VISION
NJ2128912000OtherAMERIHEALTH
NJ7386502OtherAETNA PPO
NJ8217500OtherGHI PPO
NJ91002286600OtherAMERICHOICE
NJ1784R1OtherEMPIRE BCBS
NJ52146OtherDAVIS VISION
NJP00085267OtherRAILROAD MEDICARE
NJP2738259OtherOXFORD
NJP00085267OtherRAILROAD MEDICARE
NJ064881CGSMedicare PIN