Provider Demographics
NPI:1538279575
Name:RUSSELL-VILLNOW, CHRISTIE JO (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:JO
Last Name:RUSSELL-VILLNOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CHRISTIE
Other - Middle Name:JO
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
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:
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:320-433-4326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2981152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty