Provider Demographics
NPI:1619902004
Name:RUSSELL, DANIEL F (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:F
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 EISENHOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3307
Mailing Address - Country:US
Mailing Address - Phone:814-266-8840
Mailing Address - Fax:814-266-2176
Practice Address - Street 1:865 EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3327
Practice Address - Country:US
Practice Address - Phone:814-266-8840
Practice Address - Fax:814-266-2176
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist