Provider Demographics
NPI:1356582795
Name:PINARD, RUSSELL LAWRENCE (OD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:LAWRENCE
Last Name:PINARD
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:PSC 76
Mailing Address - Street 2:BOX 5019
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96319
Mailing Address - Country:US
Mailing Address - Phone:01181311-762-6486
Mailing Address - Fax:
Practice Address - Street 1:PSC 76
Practice Address - Street 2:BOX 5019
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96319
Practice Address - Country:US
Practice Address - Phone:01181311-766-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2191152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist