Provider Demographics
NPI:1376950212
Name:RUSS, CHELSIE MICHELLE (OD)
Entity Type:Individual
Prefix:
First Name:CHELSIE
Middle Name:MICHELLE
Last Name:RUSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NW MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4025
Mailing Address - Country:US
Mailing Address - Phone:206-798-7417
Mailing Address - Fax:
Practice Address - Street 1:2201 NW MARKET ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4025
Practice Address - Country:US
Practice Address - Phone:206-789-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008184-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist