Provider Demographics
NPI:1437326493
Name:RUSSELL EYECARE & ASSOCIATES LLC
Entity Type:Organization
Organization Name:RUSSELL EYECARE & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL-VILLNOW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-224-3099
Mailing Address - Street 1:15 E MINNESOTA ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-4691
Mailing Address - Country:US
Mailing Address - Phone:320-433-4326
Mailing Address - Fax:320-262-7072
Practice Address - Street 1:15 E MINNESOTA ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SAINT JOSEPH
Practice Address - State:MN
Practice Address - Zip Code:56374-4689
Practice Address - Country:US
Practice Address - Phone:320-231-9726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2981152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6180420001Medicare NSC