Provider Demographics
NPI:1619199114
Name:RUSSO, JOSEPHINE SABRINA (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:SABRINA
Last Name:RUSSO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16 KASS ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605
Mailing Address - Country:US
Mailing Address - Phone:914-714-4660
Mailing Address - Fax:914-686-5339
Practice Address - Street 1:2365 BOSTON POST ROAD
Practice Address - Street 2:LARCHMONT EYE ASSOCIATES SUITE 202
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538
Practice Address - Country:US
Practice Address - Phone:914-834-2020
Practice Address - Fax:914-834-8206
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0057471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist