Provider Demographics
NPI:1245527548
Name:RUSSO, CINDY LEIGH (OD)
Entity type:Individual
Prefix:DR
First Name:CINDY LEIGH
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MALL RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4537
Mailing Address - Country:US
Mailing Address - Phone:781-229-2020
Mailing Address - Fax:
Practice Address - Street 1:50 MALL RD
Practice Address - Street 2:SUITE 114
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4537
Practice Address - Country:US
Practice Address - Phone:781-229-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4812152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist