Provider Demographics
NPI:1720080666
Name:RUSSIAN, CHRISTINE L (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:RUSSIAN
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 1:41 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2024
Mailing Address - Country:US
Mailing Address - Phone:781-729-6464
Mailing Address - Fax:978-458-4546
Practice Address - Street 1:9 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1927
Practice Address - Country:US
Practice Address - Phone:978-458-4546
Practice Address - Fax:978-934-9264
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3406152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA39917OtherDAVIS VISION
MA0020878OtherNEIGHBORHOOD HEALTH PLAN
MAB21030301OtherCIGNA HEALTH
MA003406OtherTUFTS HEALTH PLAN
MA0354309Medicaid
MAW15742OtherHMOBLUE
MA152567OtherHARVARD PILGRIM HEALTH
MA980955OtherNETWORK HEALTH
MAW20210OtherBC/BS OF MASS
MA60294OtherFALLON HEALTHCARE
MAW15742OtherHMOBLUE
MA0354309Medicaid