Provider Demographics
NPI:1780851170
Name:RUSSELL D SPRINGER, P.C.
Entity Type:Organization
Organization Name:RUSSELL D SPRINGER, P.C.
Other - Org Name:ATHENS FAMILY VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-543-3599
Mailing Address - Street 1:1000 HAWTHORNE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2168
Mailing Address - Country:US
Mailing Address - Phone:706-543-3599
Mailing Address - Fax:
Practice Address - Street 1:1000 HAWTHORNE AVE
Practice Address - Street 2:STE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2168
Practice Address - Country:US
Practice Address - Phone:706-543-3599
Practice Address - Fax:706-543-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2500X
GA001619332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00772098AMedicaid
GA00772098AMedicaid
U68460Medicare UPIN