Provider Demographics
NPI:1336123843
Name:SPRINGER, RUSSELL D (PC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:D
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2881
Mailing Address - Country:US
Mailing Address - Phone:706-543-3599
Mailing Address - Fax:706-543-8681
Practice Address - Street 1:270 HAWTHORNE AVE STE A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2881
Practice Address - Country:US
Practice Address - Phone:706-543-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA01619152W00000X
GAOPT001619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00772098AMedicaid
GA1841593175Medicaid
GA00772098CMedicaid
GA41ZCDGCMedicare PIN