Provider Demographics
NPI:1700409885
Name:RUSSELL N OSNES OD & ASSOCIATES PA
Entity Type:Organization
Organization Name:RUSSELL N OSNES OD & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:OSNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:651-452-0344
Mailing Address - Street 1:1340 DUCKWOOD DR STE 14
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2324
Mailing Address - Country:US
Mailing Address - Phone:651-452-0344
Mailing Address - Fax:651-452-1564
Practice Address - Street 1:1340 DUCKWOOD DR STE 14
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2324
Practice Address - Country:US
Practice Address - Phone:651-452-0344
Practice Address - Fax:651-452-1564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSSELL N OSNES OD AND ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty